Purpose: To compare the anatomical and clinical outcomes based on the distance from the corneal limbus to the scleral tunnel in flanged intrascleral intraocular lens (IOL) fixation. Methods: We retrospectively analyzed the medical records of patients who underwent scleral fixation of flanged IOLs. Group 1 (54 eyes) had a distance of 2.1 mm from the corneal limbus to the scleral tunnel, and Group 2 (48 eyes) had a distance of 2.8 mm. We evaluated the best corrected visual acuity (BCVA), postoperative complications, IOL tilt and decentration, refractive prediction error (RPE), effective lens position, and iris-IOL distance. Results: The BCVA, postoperative complications, IOL tilt, and IOL decentration did not differ between the two groups (p > 0.05). The RPE showed a hyperopic shift in Group 1 and a myopic shift in Group 2 (Group 1: +0.24 ± 0.68 D, Group 2: -0.03 ± 0.43 D, p = 0.03). The iris-IOL distance was statistically longer in Group 1 compared to Group 2 (Group 1: 1.02 ± 0.40 mm, Group 2: 0.57 ± 0.32 mm, p = 0.02). The incidence of pupillary optic capture was significantly higher in Group 2 compared to Group 1 (Group 1; 0%, Group 2; 8.3%, p = 0.03). Conclusions It should be considered that a shorter distance from the corneal limbus to the scleral tunnel results in a postoperative hyperopic shift and reduces the incidence of pupillary optic capture when performing flanged intrascleral IOLs fixation.

Background: Intravitreal ganciclovir is widely used to achieve effective local antiviral concentrations for cytomegalovirus (CMV) retinitis; however, to our knowledge, standardized dosing strategies have not been established, and the reported regimens vary considerably across studies. In this study, we evaluated dose-dependent treatment outcomes of intravitreal ganciclovir for CMV retinitis. Methods: The PubMed, Embase, Cochrane Library, and Scopus databases were searched through November 2025. Eligible studies included intravitreal ganciclovir monotherapy, with or without systemic antiviral therapy. Cumulative first-week intravitreal dose was calculated and classified as low dose (<4,000 μg) or high dose (≥4,000 μg). The pooled proportions for resolution, visual outcomes, recurrence, and retinal detachment were estimated using a random-effects model. Results: Eighteen studies comprising 1132 eyes were included across all outcomes. The pooled proportion of anatomical resolution was 89% (95% confidence interval, 0.77–0.95), and 74% of eyes maintained stable or improved vision. Recurrence and retinal detachment occurred in 12% and 9% of the eyes, respectively. High-dose regimens achieved a significantly higher resolution than low-dose regimens (94% vs. 73%, p=0.019). Visual outcomes did not differ according to dose (77% vs. 73%, p=0.646). Recurrence also showed no dose-dependent difference (14% vs. 8%, p=0.654) and was observed predominantly in patients before the introduction of highly active antiretroviral therapy. The retinal detachment rates were similar (9% vs. 10%, p=0.780). Conclusion Initial intravitreal dosing at ≥4,000 μg within the first week achieved better retinitis resolution, supporting the benefit of a higher local ganciclovir concentration in the treatment of CMV retinitis.

Purpose: To report a case of Vogt-Koyanagi-Harada-like syndrome that developed during nivolumab and ipilimumab combination immunotherapy in a patient with malignant pleural mesothelioma.Case summary: A 40-year-old female diagnosed with malignant pleural mesothelioma presented with headache and bilateral visual disturbance after receiving nivolumab and ipilimumab combination immunotherapy. Her best-corrected visual acuity was 0.6, and the intraocular pressure was 14 mmHg in both eyes. Fundus examination revealed multiple serous retinal detachment with chorioretinal folding in both eyes. The patient was diagnosed with Vogt-Koyanagi-Harada-like syndrome in both eyes, and immunotherapy with nivolumab and ipilimumab was immediately discontinued. Systemic intravenous steroid therapy was initiated, and sub-Tenon’s triamcinolone acetonide injection was administered in both eyes. After one month, the serous retinal detachment and chorioretinal folding decreased, and visual acuity improved in both eyes. Oral and eye drops of steroids were gradually tapered and discontinued after three months.However, anterior uveitis recurred in the left eye one month after discontinuation of steroids, which subsequently improved with topical steroid therapy. Conclusions The possibility of uveitis complication, such as Vogt-Koyanagi-Harada-like syndrome, should be considered in patients receiving immunotherapy with nivolumab and ipilimumab.

Purpose: We report on three patients who received 0.625% povidone-iodine (PVI) intravitreal injections to treat endophthalmitis that did not respond to conventional antibiotic treatment or were inoperable.Case summary: Case 1 was a 42-year-old female with suspected left-eye endophthalmitis that developed after anterior chamber irrigation to treat silicone oil emulsification. A 0.625% PVI intravitreal injection reduced inflammation of the anterior chamber and the vitreous. Case 2 was an 84-year-old male who was blind in the left eye due to glaucoma. He was diagnosed with endogenous endophthalmitis on the basis of the anterior chamber hypopyon and vitreous inflammation. After 0.625% PVI intravitreal injection, the endophthalmitis resolved without any recurrence. Case 3 was a 49-year-old female with suspected endogenous left-eye endophthalmitis attributable to a liver abscess. Despite intravitreal antibiotic injections, the inflammation worsened. A 0.625% PVI intravitreal injection improved both the anterior chamber and vitreous inflammation. Conclusions Intravitreal 0.625% PVI injection is a useful option when a patient with endophthalmitis is likely to not recover full vision, when surgery cannot be performed, and when there is no response to empirical antibiotics.

Purpose: To evaluate the efficacy of topical bromfenac combined with intravitreal aflibercept (IVA) injection in the treatment of exudative age-related macular degeneration over a 2-year period. Methods: We retrospectively studied 43 patients (43 eyes) with exudative age-related macular degeneration. Patients were included if they received IVA injections under an as-needed protocol and had > 2 years of follow-up. Among the 43 eyes, 25 received only IVA (IVA group), whereas 18 received a combination of IVA and topical bromfenac (bromfenac group). The primary outcome measure was the total number of IVA injections administered over 2 years from the initial injection compared between groups. We also compared changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) between groups. Results: The bromfenac group received a significantly lower number of IVA injections over 2 years (7.4 ± 1.0), compared with the IVA group (9.0 ± 1.9) (p < 0.01). Both groups showed improvements in BCVA and CRT after 2 years compared with their baseline values. However, changes in BCVA and CRT at 2 years did not significantly differ between groups (p = 0.786 and p = 0.905, respectively). Conclusions Among patients with exudative age-related macular degeneration, the total number of IVA injections over 2 years was lower in the bromfenac group than in the IVA group. More studies are needed to confirm the efficacy of topical bromfenac in a combined treatment regimen.

Purpose: To evaluate the efficacy of topical bromfenac in treating central serous chorioretinopathy (CSC) over a 1-year period. Methods: A retrospective analysis was conducted on 57 patients (57 eyes) with CSC followed for > 1 year. Patients were divided into two groups: those treated with bromfenac eye drops twice daily (29 eyes) and a control group (28 eyes). Best-corrected visual acuity (BCVA), central macular thickness (CMT), and subretinal fluid (SRF) height were measured and compared between the two groups as was the proportion of chronic cases. Results: Significant improvements in CMT and SRF height were noted in both groups over the follow-up period. The bromfenac group demonstrated significantly lower CMT at 6, 9, and 12 months (p = 0.045, 0.042, and 0.023, respectively) and lower SRF height (p = 0.037, 0.048, and 0.046, respectively) compared to the control group. The proportion of chronic cases was significantly lower in the bromfenac group (17.2%) compared to the control group (42.9%, p = 0.035). Conclusions Topical bromfenac reduced the rate of progression to chronic CSC and showed significant anatomical improvements after 6 months, suggesting its potential as an effective treatment option.

Purpose: To report a case of exudative retinal detachment after using pembrolizumab in a patient with metastatic cutaneous melanoma.Case summary: A 67-year-old woman, diagnosed with malignant melanoma of the right thumb and axillary metastasis, presented with bilateral visual disturbance 3 days after adjuvant chemotherapy with pembrolizumab. Her best corrected visual acuity was 0.2 in the right eye and 0.7 in the left, while the intraocular pressure was 14 mmHg in both eyes. Fundus examination showed serous retinal detachment and choroidal detachment in the right eye, as well as a chorioretinal folding in both eyes. Optical coherence tomography showed exudative retinal detachment and choroidal detachment in the right eye, along with choroidal folding in both eyes. The pembrolizumab was stopped immediately, and the patient began treatment with systemic and topical steroids. After 1 month, the visual acuity improved and there was no exudative retinal detachment or choroidal detachment. However, 3 weeks later, exudative retinal detachment recurred in both eyes. The patient started treatment with oral steroids and cyclosporine, which resulted in the resolution of the exudative retinal detachment after 1 month. Conclusions Exudative retinal detachment may occur as a side effect of pembrolizumab treatment. Therefore, a differential diagnosis and appropriate treatment of ocular side effects are necessary.

Purpose: We report a case of retinopathy related to bilateral hyperviscosity syndrome in a patient with Waldenström macroglobulinemia.Case summary: A 77-year-old male presented with reduced visual acuities of both eyes 2 months in duration. Fundus examination revealed extensive flame-shaped retinal hemorrhages and venous congestion. Optical coherence tomography (OCT) evidenced macular edema and OCT angiography (OCTA) indicated damage to the superficial and deep capillary plexi of retina and choriocapillaris and dilated large choroidal vessels. We diagnosed central retinal vein occlusion with macular edema and prescribed intravitreal bevacizumab and posterior subtenon triamcinolone injections, however, the edema did not improve. As retinopathy associated with hematological disease was thus suspected, we referred the patient to our department of hematology and oncology for further assessment. He was diagnosed with Waldenström macroglobulinemia. After initiation of chemotherapy, the retinal hemorrhage in and macular edema of both eyes decreased. After six chemotherapy cycles, the retinal hemorrhages resolved and the macular edema improved in both eyes. OCTA revealed that the choroidal vessel dilation also improved. Conclusions In elderly patients presenting with central retinal vein occlusions and macular edema of both eyes, it is important to assess whether the retinopathy is associated with a hyperviscosity syndrome linked to a hematological disease.

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.
Abdomen ; Budgets ; Chest Pain ; Critical Care ; Dyspnea ; Emergencies ; Heart ; Heart Arrest ; Insurance Coverage ; Insurance ; Insurance, Health ; Korea ; Medical Records ; National Health Programs ; Patient Care ; Point-of-Care Systems ; Prescriptions ; Shock ; Thorax ; Ultrasonography

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.