PURPOSE: To report a rare case of relapsed inflammatory choroidal neovascularization (CNV) in a young female patient after intravitreal bevacizumab (IVB) treatment for subfoveal CNV secondary to punctate inner choroidopathy (PIC). CASE SUMMARY: A 25-year-old myopic female presented with PIC complicated by subfoveal CNV in the right eye. Her lesion initially responded to three monthly 1.25 mg IVB injections, but the lesion recurred two months after the final injection, and the size of the lesion was larger than that observed before treatment. Further treatment with systemic steroids and IVB resulted in successful anatomic and visual improvement. CONCLUSIONS: This report presents a rare case of relapsed inflammatory CNV in a young female patient after IVB treatment for subfoveal CNV secondary to PIC. Systemic steroid and IVB were performed after relapse, which successfully improved and maintained vision for longer than 18 months.
Adult ; Choroid* ; Choroidal Neovascularization* ; Female ; Humans ; Recurrence ; Steroids ; Bevacizumab

PURPOSE: To report the manifestation of ocular syphilis combined with neurosyphilis in patients who present with uveitis clinically and are diagnosed initially by an ophthalmologist. METHODS: This study is a retrospective, clinical investigation of seven male patients with ocular syphilis from a single tertiary center between 2009 and 2012. RESULTS: The average age of the patients at onset was 44.4 years (range, 33-71 years). Posterior segment involvement was found in all patients. Two patients had papillitis. In serologic testing, all patients had positive responses to Venereal Disease Research Laboratory (VDRL), fluorescent treponemal antibody-absorption test (FTA-ABS) and Treponema pallidum hemagglutination (TPHA). In fluorescein angiography (FAG), retinal vascular and disc leakage was the most common finding. Cerebrospinal fluid (CSF) analysis was performed for six patients and demonstrated positive CSF FTA-ABS and CSF TPHA tests in all patients. CSF VDRL was reactive in 2 patients (33.3%). CONCLUSIONS: All patients with ocular syphilis were diagnosed with neurosyphilis based on the analysis of CSF with FTA-ABS and TPHA. Ophthalmologists play an important role in the early diagnosis and treatment of syphilis.
Cerebrospinal Fluid ; Early Diagnosis ; Fluorescein Angiography ; Fluorescent Treponemal Antibody-Absorption Test ; Hemagglutination ; Humans ; Male ; Neurosyphilis* ; Papilledema ; Retinaldehyde ; Retrospective Studies ; Serologic Tests ; Sexually Transmitted Diseases ; Syphilis* ; Treponema pallidum ; Uveitis

PURPOSE: To compare the choroidal thickness of unaffected and affected eyes in children with unilateral high myopia when measured using enhanced depth imaging and to analyze the relationship among choroidal thickness and axial length, spherical equivalent and best corrected visual acuity (BCVA). METHODS: Twenty children with high unilateral high myopia who received optical coherence tomography from December 2012 to May 2014 were retrospectively analyzed. Choroidal thickness was measured with a caliper at 500 microm apart from fovea superiorly and inferiorly, 2,500 microm apart nasally and at 2,500 microm apart temporally at 500 microm intervals. For statistical analyses, paired t-test was used for choroidal thickness and linear regression analysis for the relationship among choroidal thickness and axial length, spherical equivalent and BCVA. RESULTS: The patients were 10.4 +/- 3.5 years of age and the average BCVA of myopic eye was 0.38 +/- 0.2. Mean spherical equivalent was -9.8 +/- 1.9D. The choroidal thickness was significantly thinner in the myopic eye (102.5 +/- 16.9 microm) than the fellow eye (282.9 +/- 14.0 microm). The thickest choroid in the myopic eye was the temporal and the thinnest was the nasal area (p = 0.008). Choroidal thickness was significantly associated with axial length and spherical equivalent but not BCVA. CONCLUSIONS: Highly myopic eyes tend to have thinner choroidal thickness than the fellow eyes and choroidal thickness tends to be thicker temporally. Therefore, several anatomical changes in unilateral highly myopic children may exist.
Child* ; Choroid* ; Humans ; Linear Models ; Myopia* ; Retrospective Studies* ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To compare the two transscleral fixation (TSF) techniques of intrascleral pocket and conventional scleral flap with conjunctival division techniques in terms of short-term clinical effects. METHODS: This retrospective cohort study included all consecutive patients with aphakia in Gyeongsang National University Hospital in Jinju, Korea, who underwent TSF between January 2012 and December 2014. The medical records of all patients were retrospectively reviewed, and the endothelial cell count (ECC), refraction, best-corrected visual acuity (BCVA), intraocular pressure, slit lamp, and fundus examination results before and 1 day and 6 months after surgery were recorded. The postoperative complications and visual outcomes were also recorded. RESULTS: The intrascleral pocket and conventional-flap groups did not differ significantly in terms of demographics, presurgical BCVA, or ECC. However, the intrascleral pocket group had a significantly lower BCVA at 1 day and 6 months after surgery compared to the conventional-flap group. The two groups did not differ in terms of ECC 6 months after surgery. The intrascleral pocket group had no postoperative complications, but five patients in the conventional-flap group complained of irritation. In both groups, the intraocular lens was well positioned without tilting or subluxation, and astigmatism was significantly reduced at 1 day and 6 months after surgery. CONCLUSIONS: The intrascleral pocket technique of TSF does not involve conjunctival dissection and is a successful method of sulcus fixation. It stably corrects the intraocular lens and is easy to perform, which helps to reduce operation time. It also reliably yields rapid visual acuity recovery without complications.
Aphakia ; Astigmatism ; Cohort Studies* ; Demography ; Endothelial Cells ; Gyeongsangnam-do ; Humans ; Intraocular Pressure ; Korea ; Lenses, Intraocular ; Medical Records ; Postoperative Complications ; Retrospective Studies* ; Visual Acuity

In this case series, we assessed a new technique, the intrascleral pocket procedure of transscleral fixation (TF) of the intraocular lens (IOL) in post-vitrectomized eyes. We performed the transscleral fixation of IOL in four aphakic patients who underwent pars plana vitrectomy. Two points 180degrees apart were marked at the limbus. A 2-mm-sized intrascleral pocket was created by lamellar dissection using a crescent blade without conjunctival dissection. A 2.8-mm clear corneal incision (CCI) was made using a keratome. Prolene sutures were exteriorized through the CCI pocket and a three-piece foldable acrylic IOL was injected via CCI and the ends of the haptics were exteriorized through the CCI. The prolene sutures for each haptic in the intrascleral pocket bed were then tied and knots were buried under scleral flaps. No patient had complaints such as conjunctival irritation, and visual acuity was almost identical to preoperative best-corrected visual acuity at day 1 postoperatively. IOLs were well placed without tilting or subluxation. They had no wound dehiscence or endophthalmitis postoperatively. The intrascleral pocket procedure of TF without the need for conjunctival dissection is a successful method for sulcus fixation in post-vitrectomized eyes predisposed to developing glaucoma.
Aged ; Aged, 80 and over ; Aphakia/*surgery ; Female ; Humans ; Lens Implantation, Intraocular/*methods ; *Lenses, Intraocular ; Male ; Middle Aged ; Sclera/*surgery ; Sutures ; Treatment Outcome ; *Vitrectomy

Purpose: To report a case of acute angle-closure attack resulting from hemorrhagic retinal detachment after a double retinal pigment epithelium (RPE) tear in exudative age-related macular degeneration (AMD) with large pigment epithelial detachment (PED).Case summary: A 66-year-old female visited with a complaint of poor vision in left eye, which began 1 month prior. She was diagnosed with exudative AMD with a large PED using optical coherence tomography and indocyanine green angiography. Intravitreal aflibercept injection was performed. The RPE tear occurred at 2 weeks after the intravitreal anti-vascular endothelial growth factor injection for AMD, after which the range of the RPE tear expanded and included the macular area at 4 weeks after the second injection. At 3 months after the third injection, massive submacular hemorrhage occurred; aflibercept injection was repeated. At 3 days after the fourth injection, the patient’s intraocular pressure (IOP) was 60 mmHg, and massive hemorrhagic serous retinal detachment and anterior movement of the lens with total angle closure were observed. Therefore, we performed a sclerotomy; a large amount of dark blood and subretinal fluid was drained. The IOP decreased, and the retinal detachment improved somewhat. The patient was kept under observation for careful monitoring of her condition. Conclusions It is very rare to experience a double RPE rupture after intravitreal anti-vascular endothelial growth factor injection in AMD. We report on our experience and treatment of acute angle-closure attack. The IOP increased due to hemorrhagic retinal detachment after a double RPE tear over the treatment course.

Purpose: This study investigated the 1-year outcomes of a treat-and-extend regimen of ranibizumab for exudative age-related macular degeneration and examined the clinical results when drug treatment was changed within the same period. Methods: This retrospective analysis included 32 eyes first diagnosed with wet age-related macular degeneration and treated for more than 1 year with a treat-and-extend regimen of ranibizumab, as well as 24 eyes treated by changing from ranibizumab to aflibercept within the same period. The injection number, maximum injection interval, change in central retinal thickness, and best-corrected visual acuity were assessed in all eyes. Results: In 32 eyes that received a treat-and-extend regimen of ranibizumab, the mean best-corrected visual acuity improved from 59.46 ± 15.13 to 68.00 ± 12.48 at 12 months (p < 0.0001). The mean central retinal thickness decreased from 409 ± 141 μm to 273 ± 89 μm at 12 months (p < 0.0001). The average number of injections per year was 7.2 ± 0.85. One complication related to the 12 months of injections was a tear in the retinal pigment epithelium; no systemic complications were observed. Of 24 eyes that underwent a change in medication, the rate of maintenance or improvement in initial visual acuity was 83% (10 eyes). The central retinal thickness was initially 371.58 ± 109.96 μm, but improved to 290.33 ± 58.66 μm in 12 eyes that received three injections of aflibercept. Conclusions At 1 year, good outcomes were obtained using treat-and-extend ranibizumab for exudative age-related macular degeneration. When the treatment was changed to aflibercept within the same period, vision was often maintained and short-term anatomical improvement was evident.

Purpose: To report a squamous cell carcinoma in the lacrimal sac of a young patient.Case summary: A 30-year-old female patient who had a history of conjunctival squamous papilloma resected at 15 years of age complained of pain and a mass around the right lacrimal sac that had occurred 1 week prior. Antibiotic treatment for 10 days under suspicion of dacryocystitis did not relieve her symptoms. After being diagnosed with lacrimal sac obstruction after dacryocystography, a 1.7 × 1.7 cm round mass was found on orbit non-contrast computed tomography. Endonasal dacryocystorhinostomy and excisional biopsy were performed. Histopathological examination revealed the initial invasive squamous cell carcinoma. An additional resected tissue biopsy was performed later. The mass diagnosed as carcinoma was completely resected and it was confirmed that there were no malignant cells around the resected area. Conclusions Squamous cell carcinoma of the lacrimal sac is rare and is known to be less common in young patients. It is believed that this case should not exclude the possibility of malignant tumors of the lacrimal sac regardless of age. Given that squamous cell carcinoma of the lacrimal sac is associated with a high-risk of human papillomavirus, this disease should be considered if there is a history of papilloma.

Purpose: To evaluate the results of treatment according to the method of intravitreal injection of bevacizumab for macular edema due to branch retinal vein occlusion (BRVO). Methods: The clinical records of macular edema patients were analyzed retrospectively for a total of 62 eyes of 62 patients who were injected with bevacizumab into the vitreous as the first treatment for BRVO. Best-corrected visual acuity (BCVA), the findings of spectral-domain optical coherence tomography before and after injection, and prognosis-related factors were evaluated for 21 eyes that received the initial three monthly loading treatments and the 41 eyes that did not. Results: Significant improvement in BCVA was observed in the group having received the initial three injections compared with the group who did not receive the injections at 3, 6, and 12 months (p = 0.025, p = 0.019, and p = 0.008, respectively). The central macular thickness (CMT) showed greater improvement in the initial three injections group than the group without at 6 months (p = 0.034). Multivariate regression showed that the duration from the onset, the three loadings, BCVA, disorganization of the retinal inner layer (DRIL), and choroidal thickness were predictors related to visual gain (p = 0.044, p = 0.047, p = 0.004, p = 0.045, and p = 0.034, respectively). Age, three loadings, BCVA, and DRIL were predictors related to final visual acuity (p = 0.045, p = 0.046, p = 0.002, and p = 0.034, respectively). Duration from the onset, CMT, and choroidal thickness were predictors related to CMT improvement (p = 0.042, p = 0.009, and p = 0.015, respectively). Conclusions In macular edema of BRVO, the initial three monthly intravitreal injections of bevacizumab provided superior treatment outcomes regarding short-term functional and anatomical improvements and long-term functional improvement, compared with methods that did not treat with the initial three monthly injections.

Purpose: Here, we report a case of a fungal corneal ulcer caused by Talaromyces allahabadensis (T. allahabadensis).Case summary: A 69-year-old male was admitted to our hospital with pain and hyperemia in his left eye after 2 months of treatmentat a local clinic for herpetic keratitis. The patient had a previous history of trauma to his left eye caused by a persimmon treebranch. He had a peripheral epithelial defect, stromal infiltration, and severe corneal edema in his left eye. Gram staining, a KOHsmear, and a culture were performed using corneal specimens; the results were all negative. With the assumption of herpetickeratitis, antiviral and empirical antibiotic treatments were started. After 2 weeks, the stromal infiltrations on his left eye increased,so we again conducted staining and culture studies. T. allahabadensis was isolated from a specimen, so treatment wasstarted using antifungal agents, and a conjunctival flap graft was performed due to the risk of a corneal perforation. Conclusions A case of corneal ulcer caused by T. allahabadensis in a patient with posttraumatic herpetic keratitis was successfullytreated with antifungal agents and conjunctival flap surgery.