PURPOSE: To determine normal retinal nerve fiber layer (RNFL) thickness by age and to investigate the relationships of the RNFL with clinical variables using spectral domain optical coherence tomography (SD-OCT) in healthy Koreans. METHODS: The peripapillary RNFL thicknesses were measured around the optic disc using consecutive circular B-scans with 3.5 mm diameter and automatically calculated using a SD-OCT. RESULTS: Three hundreds fifty-two eyes of 205 healthy subjects were included in the study and RNFL thickness were measured by SD-OCT. Overall average RNFL thickness was 100.2 ± 10.9 µm, and significantly and negatively correlated with age (r = −0.164, p = 0.002). The overall average RNFL thickness decrease per decade was 0.8 µm (95% confidence interval, −0.3 to −1.3, p = 0.019). Mean RNFL thickness of each quadrant was significantly correlated with axial length except in the superior quadrant. CONCLUSIONS: This study describes the normal RNFL thickness values of Koreans as determined by SD-OCT. Furthermore, age was found to be correlated with normal RNFL thickness, however age-related changes were not uniform across every region.
Clothing ; Healthy Volunteers ; Nerve Fibers ; Retinaldehyde ; Tomography, Optical Coherence

Purpose: Here, we report a case of acute noninfectious endophthalmitis after removal of silicone oil (SO) and posterior capsulectomy in a patient with proliferative diabetic retinopathy.Case summary: SO removal and posterior capsulectomy were performed in a 61-year-old man who had undergone vitrectomy with combined cataract surgery, membrane peeling, laser photocoagulation, and SO injection to treat vitreous hemorrhage and tractional retinal detachment three months previously. The patient’s best-corrected visual acuity on the day after surgery was 20/50; it decreased to hand motion at five days after SO removal. Exudative membrane with hypopyon, anterior chamber cell (trace), and mild conjunctival injection were observed. The patient did not complain of ocular pain. Topical steroid was applied following a diagnosis of postoperative noninfectious endophthalmitis. The exudative membrane and hypopyon decreased after three days of treatment and had resolved completely after one month of treatment. The patient’s visual acuity improved to 20/50. Conclusions Noninfectious endophthalmitis can develop after removal of SO and posterior capsulectomy. Topical steroid treatment is effective in such cases.

Purpose: We report bilateral, diffuse, uveal melanocytic proliferation caused by a stomach adenocarcinoma.Case summary: A 78-year-old male complained of visual impairment 3 months in duration. He had diabetes and had undergone cataract surgery on both eyes 4 years prior. His best-corrected visual acuity was counting fingers in the right eye and 20/160 in the left eye. Both intraocular pressures were normal. The anterior segments yielded no specific findings. The maculae exhibited multiple, round, patchy, pigmented or depigmented lesions with exudative retinal detachment. Fluorescein angiography revealed multiple hyperfluorescent lesions. Optical coherence tomography revealed that the hyper-reflective exudates lay between the neurosensory retina and the retinal pigment epithelium. We diagnosed bilateral, diffuse, uveal melanocytic proliferation and performed a systemic evaluation. Computed tomography revealed several mass lesions in the lung, stomach, and lymph nodes; these appeared to be malignant. An esophagogastroduodenoscopic biopsy confirmed that the lesions were adenocarcinomas. Conclusions A bilateral, diffuse, uveal melanocytic proliferation induced by a primary malignant tumor exhibited multiple, pigmented subretinal exudates associated with exudative macular retinal detachment. In patients with such findings, it is necessary to evaluate the malignant tumor status of remote organs.

Background: This study evaluated the Blossom system, an innovative self-filling, rate-controlled, pressure-responsive saline tissue expander (TE) system. We investigated the feasibility of utilizing this technology to facilitate implant-based and combined flap with implant-based breast reconstruction in comparison to conventional tissue expansion. Methods: In this prospective, single-center, single-surgeon pilot study, participants underwent either implant-based breast reconstruction or a combination of autologous flap and implantbased breast reconstruction. Outcome measures included time to full expansion, complications, total expansion volume, and pain scores. Results: Fourteen patients (TEs; n=22), were included in this study. The mean time to full expansion was 13.4 days (standard error of the mean [SEM], 1.3 days) in the combination group and 11.7 days (SEM, 1.4 days) in the implant group (P=0.78). The overall major complication rate was 4.5% (n=1). No statistically significant differences were found in the complication rate between the combination group and the implant group. The maximum patient-reported pain scores during the expansion process were low, but were significantly higher in the combination group (mean, 2.00±0.09) than in the implant group (mean, 0.29±0.25; P=0.005). Conclusions The reported average duration for conventional subcutaneous TE expansion is 79.4 days, but this pilot study using the Blossom system achieved an average expansion duration of less than 14 days in both groups. The Blossom system may accommodate single-stage breast reconstruction. The overall complication rate of this study was 4.5%, which is promising compared to the reported complication rates of two-stage breast reconstruction with TEs (20%–45%).

PURPOSE: Among available biomaterials, bioceramics have drawn special interest due to their bioactivity and the possibility of tailoring their composition. The degradation rate and formulation of bioceramics can be altered to mimic the compositions of the mineral phase of bone. The aim of this study was to investigate the bone formation effect of amorphous calcium phosphate glass cement (CPGC) synthesized by a melting and quenching process. METHODS: In five male beagle dogs, 4 x 4 mm 1-wall intrabony defects were created bilaterally at the mesial or distal aspect of the mandibular second and fourth premolars. Each of the four defects was divided according to graft materials: CPGC with collagen membrane (CM), biphasic calcium phosphate (BCP) with CM, CM alone, or a surgical flap operation only. The dogs were sacrificed 8 weeks post-surgery, and block sections of the defects were collected for histologic and histometric analysis. RESULTS: There were significant differences in bone formation and cementum regeneration between the experimental and control groups. In particular, the CPGC and BCP groups showed greater bone formation than the CM and control groups. CONCLUSIONS: In conclusion, CPGC was replaced rapidly with an abundant volume of new bone; CPGC also contributed slightly to regeneration of the periodontal apparatus.
Animals ; Bicuspid ; Biocompatible Materials ; Bone Substitutes ; Calcium ; Calcium Phosphates ; Collagen ; Dental Cementum ; Dogs ; Freezing ; Glass ; Humans ; Hydrazines ; Hydroxyapatites ; Male ; Membranes ; Osteogenesis ; Regeneration ; Surgical Flaps ; Transplants

Purpose: To report a case of Streptococcus infantarius endophthalmitis related to the use of a XEN® Gel Stent.Case summary: A 75-year-old male was referred to our practice with a diagnosis of endophthalmitis 55 days after XEN® Gel Stent implantation. He had primary open-angle glaucoma. Visual acuity was 20/50. Slit-lamp examination revealed conjunctival injection and anterior chamber inflammation with hypopyon. Fundus examination showed inflammatory cells with exudative materials in the vitreous. The aqueous sampling for culture of causative micro-organisms was followed by removal of the XEN® Gel Stent, along with anterior chamber irrigation and intracameral and intravitreal injection of antibiotics. Streptococcus infantarius was isolated after 5 days. Vitrectomy, anterior chamber lavage, and intravitreal injection of antibiotics were additionally performed to control the intraocular inflammation. Sixteen days after vitrectomy, the intraocular inflammation disappeared. The choroidal detachment was resolved 34 days after vitrectomy. Visual improvement was limited to 20/100 at 6 months. Conclusions XEN® Gel Stent-related bacterial endophthalmitis was successfully treated by implant removal, vitrectomy, and proper intraocular antibiotic treatment.

Purpose: To investigate the changes in intraocular cytokines after ranibizumab treatment in patients with polypoidal choroidal vasculopathy (PCV). Methods: This multicenter, prospective study enrolled patients with PCV treated with three monthly ranibizumab followed by a pro re nata regimen for 24 weeks. Best corrected visual acuity, slit lamp examination, fundus photography, and optical coherence tomography were performed every 4 weeks. Aqueous humor was collected to measure intraocular cytokines at baseline, week 8, and the time of recurrence or week 20. The association of changes in intraocular cytokines with visual acuity, central macular thickness, central choroidal thickness, area of abnormal vessels, and polyp closure was assessed. Results: This study included 25 eyes. The mean patient age was 70.3 ± 6.1 years. The vascular endothelial growth factor (VEGF) concentration decreased at week 8, but only interferon (IFN)-γ, tissue inhibitors of matrix metalloproteinases (TIMP)-2, and monocyte chemoattractant protein (MCP)-2 decreased at the time of recurrence. The recurrence interval was positively associated with the baseline epithelial-neutrophil activating peptide (ENA)-78, interleukin (IL)-17, leptin, and transforming growth factor-β1, and baseline central macular thickness was positively correlated with the baseline fibroblast growth factor-4 and IL-10. Thick central choroidal thickness was associated with a low basic fibroblast growth factor and high IFN-γ at baseline. The MCP-3 and Tie-2 levels decreased in two eyes with polyp closure. Conclusions Ranibizumab significantly reduced intraocular VEGF concentrations and consequently improved PCV. However, the cytokines IFN-γ, TIMP-2, and MCP-2, rather than VEGF, were associated with PCV recurrence. Further studies of intraocular cytokines involved in neovascularization in PCV are needed.

Purpose: We report a case of infectious scleritis featuring kissing choroidal detachment and serous retinal detachment.Case summary: A 65-year-old female presented with ocular pain and hyperemia of the right eye 1 week in duration. Anterior chamber inflammation was evident. After pterygium excision, a thinned sclera and loss of conjunctiva around a necrotic lesion were observed. Necrotizing scleritis with anterior uveitis was diagnosed and topical and systemic steroids commenced. After 1 week, the scleral thickness increased, but conjunctival injection and choroidal detachment were newly noticed. Infectious scleritis was suspected and the pterygium excision site cultured. Although empirical antibiotics (fortified ceftazidime and tobramycin) were prescribed, the choroidal and serous retinal detachments became aggravated. Pseudomonas aeruginosa was identified on scleral culture, and topical piperacillin/tazobactam and systemic cefepime (2 g) commenced. Although the antibiotics were appropriate, the choroidal and serous retinal detachments became further aggravated. Necrotic tissue was subjected to surgical debridement. Two days later, the infectious signs had diminished and a systemic steroid was added. Over the next few weeks, all of the choroidal and serous retinal detachments, and the infectious signs, improved. Conclusions Patients with infectious scleritis featuring severe choroidal detachment and serous retinal detachment resistant to appropriate antibiotics may require surgical debridement of necrotic tissue. After controlling the infectious signs, systemic steroids should be considered to ensure a good prognosis.

Purpose: To report complications requiring surgical management related to intravitreal dexamethasone implant. Methods: The medical records of patients who received intravitreal dexamethasone implant injection from June 2013 to March 2020 were reviewed retrospectively. Patients who had undergone intraocular surgical management within 6 months after implant injection, with the exception of cataract surgery, were included. Of them, only the cases in which the surgery was definitely related to complications with the Ozurdex implant were included. In these patients, underlying disease, intraocular pressure change, and the number of injections were analyzed. Results: A total of 1,168 injections of 473 eyes (439 patients) were enrolled in the study. The mean number of injections was 2.5 per eye. The mean age was 61.4 ± 11.3 years. The complications requiring an additional surgical procedure occurred in six (0.5%) injections. Of them, four, one, and one eyes showed uveitis, diabetic macular edema, and branch retinal vein occlusion, respectively. Surgical management was performed to control the increased intraocular pressure in two eyes, inappropriate implant location in two eyes, scleral wound leakage in one eye, and retinal detachment in one eye. The incidence of severe complications requiring surgical management was high in cases with a history of previous vitrectomy (p = 0.007, Fisher’s exact test) and uveitis (p = 0.007, Fisher’s exact test). Conclusions Severe complications requiring surgical management occurred in 0.5% of cases (six cases) after intravitreal dexamethasone implant injections. These complications were related to a history of previous vitrectomy and uveitis. Five eyes recovered to favorable visual function after surgery, with the exception of one eye with retinal detachment.

Purpose: We report a case of infectious scleritis featuring kissing choroidal detachment and serous retinal detachment.Case summary: A 65-year-old female presented with ocular pain and hyperemia of the right eye 1 week in duration. Anterior chamber inflammation was evident. After pterygium excision, a thinned sclera and loss of conjunctiva around a necrotic lesion were observed. Necrotizing scleritis with anterior uveitis was diagnosed and topical and systemic steroids commenced. After 1 week, the scleral thickness increased, but conjunctival injection and choroidal detachment were newly noticed. Infectious scleritis was suspected and the pterygium excision site cultured. Although empirical antibiotics (fortified ceftazidime and tobramycin) were prescribed, the choroidal and serous retinal detachments became aggravated. Pseudomonas aeruginosa was identified on scleral culture, and topical piperacillin/tazobactam and systemic cefepime (2 g) commenced. Although the antibiotics were appropriate, the choroidal and serous retinal detachments became further aggravated. Necrotic tissue was subjected to surgical debridement. Two days later, the infectious signs had diminished and a systemic steroid was added. Over the next few weeks, all of the choroidal and serous retinal detachments, and the infectious signs, improved. Conclusions Patients with infectious scleritis featuring severe choroidal detachment and serous retinal detachment resistant to appropriate antibiotics may require surgical debridement of necrotic tissue. After controlling the infectious signs, systemic steroids should be considered to ensure a good prognosis.