PURPOSE: To report a case of focal choroidal excavation associated with central serous chorioretinopathy. CASE SUMMARY: A 48-year-old female presented with a 20-year history of visual disturbance. Focal choroidal excavation with neurosensory retinal detachment was detected in the right eye on optical coherence tomography. Fluorescein angiography showed hyperfluorescene in the area of excavation and multiple focal hyperfluorescences in the perimacular area. Vertically linear hyperfluorescene line was detected in the excavated area caused by retinal pigment epithelial atrophy. Based on the 2 diagnostic findings, we diagnosed a focal choroidal excavation with central serous chorioretinopathy. No progression was detected for 2 months.
Atrophy ; Central Serous Chorioretinopathy* ; Choroid* ; Female ; Fluorescein Angiography ; Humans ; Middle Aged ; Retinal Detachment ; Retinaldehyde ; Tomography, Optical Coherence

PURPOSE: In the present study we analyzed the leading diseases causing epiretinal membrane and compared the prognosis after epiretinal membrane peeling. METHODS: We enrolled 158 (160 eyes) patients diagnosed with epiretinal membrane who underwent epiretinal membrane peeling from January 2005 to January 2014. The medical records including age, underlying ocular disease, and pre-operative symptoms of patients from Chonbuk National University Hospital were analyzed retrospectively. Additionally, we evaluated the changes in central macular thickness and visual acuity after the epiretinal membrane peeling. RESULTS: Idiopathic epiretinal membrane was the most common type of disease (44.4%, 71/160). The causes of secondary epiretinal membrane were diabetic retinopathy (20.6%, 33/160), retinal tear, and retinal hole (18.1%, 29/160). Other causes were post retinal detachment surgery, traumatic epiretinal membrane, retinal vein occlusion and uveitis; 6.9% (11/160), 4.4% (7/160), 3.8% (6/160), and 1.9% (3/160), respectively. The changes in central macular thickness after surgery did not differ significantly between the idiopathic epiretinal membrane and secondary epiretinal membrane patients after adjusting for age (p = 0.958, based on analysis of variance (ANOVA). Additionally, the visual acuity did not differ significantly after the surgery even after adjusting for age (p = 0.118, analysis of covariance [ANCOVA]). CONCLUSIONS: Various ocular diseases can be the leading causes of epiretinal membrane, but the leading disease does not affect the degree of central macular thickness changes after surgery or change the prognosis of post-surgical visual acuity.
Diabetic Retinopathy ; Epiretinal Membrane* ; Humans ; Jeollabuk-do ; Medical Records ; Prognosis* ; Retinal Detachment ; Retinal Perforations ; Retinal Vein Occlusion ; Retrospective Studies ; Uveitis ; Visual Acuity

PURPOSE: To evaluate the factors influencing the effect of the intravitreal bevacizumab injection in patients with central serous chorioretinopathy. METHODS: We performed a retrospective review of the medical records of 54 patients (56 eyes) who had been symptomatic for more than 3 months with central serous chorioretinopathy (CSC), who had undergone intravitreal bevacizumab injection and been on regular follow-up for at least 6 months. RESULTS: Responders were 34 eyes (60.7%) and non-responders were 22 eyes (39.3%). The leaking points of the non-responder group were multiple and located more centrally than that of the responder group on fluorescein angiography (FA) (p = 0.01, p = 0.044). In addition, non-responder group showed cystoid macular edema on optical coherence tomography (OCT) as compared with responder group (p = 0.042). CONCLUSIONS: CSC with multiple, centrally located leaks on FA or cystoid macular edema on OCT was ineffective or recurrent with intravitreal bevacizumab injection.
Central Serous Chorioretinopathy* ; Fluorescein Angiography ; Follow-Up Studies ; Humans ; Macular Edema ; Medical Records ; Retrospective Studies ; Tomography, Optical Coherence ; Bevacizumab

PURPOSE: To evaluate the characteristics of choroidal nevus using the enhanced depth imaging spectral domain optical coherence tomography (EDI SD-OCT), with a comparison to the B scan ultrasound (BUS) findings. METHODS: Medical records of 124 eyes of 124 choroidal nevus patients were reviewed retrospectively. All patients underwent fundus photography (FP), EDI SD-OCT, and BUS. RESULTS: Of 124 eyes with choroidal nevus examined by EDI SD-OCT, 43 eyes (35%) displayed good images to study. The most common EDI-OCT imaging features included choroidal shadowing, choriocapillary thinning, retinal pigment epithelial changes, and overlying subretinal fluid. The mean nevus thickness was 817 microm (120-1850 microm) by EDI-OCT compared 1295 microm (780-2400 microm) by BUS. The mean difference in the tumor thickness between two techniques was 475 microm (27-1319 microm) (p < 0.05). CONCLUSIONS: These results have suggested that imaging of choroidal nevus with EDI-OCT shows superior measurement of its characteristics compared with ultrasonography. The clinical utility of this modality is emerging. EDI-OCT is useful in distinguishing suspicious nevi from other chorioretinal lesions, detecting tumor re-growth along the treatment margin, and demonstrating retinal or choroid tumor location.
Choroid* ; Humans ; Medical Records ; Nevus* ; Photography ; Retinaldehyde ; Retrospective Studies ; Shadowing (Histology) ; Subretinal Fluid ; Tomography, Optical Coherence* ; Ultrasonography*

PURPOSE: To determine whether rat eyes develop increases in intraocular pressure (IOP) in response to a topically applied corticosteroid and to investigate the relationship between ocular hypertension and apoptosis of retinal ganglion cells. METHODS: IOP was monitored by rebound tonometry in a group of 10 rats that received topically administered dexamethasone in both eyes (experimental) and in another group of 5 rats that received artificial tears (control) three times daily for 4 weeks after the establishment of baseline IOP values. Only eyes that increased by more than 50% compared with the basal IOP were administered once per day for 5 weeks. After 8 weeks, selective immunofluorescence stain for retinal ganglion cells and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) stain were conducted. RESULTS: Among 20 experimental eyes, 11 eyes (55%) showed a greater than 50% increase in IOP compared with basal IOP. After 8 weeks, the mean IOPs for the experimental and control groups were 11.8 +/- 1.4 mm Hg and 18.5 +/- 1.0 mm Hg, respectively (p < 0.01). The counts of central retinal ganglion cells (RGCs) were 2718 +/- 240 and 2612 +/- 443, respectively (p = 0.294). The results of the TUNEL stain also showed no differences. CONCLUSIONS: Rat eyes exhibit a steroid-induced ocular hypertensive response with no local complications. However, maintaining ocular hypertension increased by 50% for two months was not enough to detect changes in RGCs.
Animals ; Apoptosis ; Dexamethasone ; DNA Nucleotidylexotransferase ; Fluorescent Antibody Technique ; In Situ Nick-End Labeling ; Intraocular Pressure ; Manometry ; Mice* ; Ocular Hypertension* ; Ophthalmic Solutions ; Rats ; Retinal Ganglion Cells

BACKGROUND: The purpose of this study is to know the healthcare-associated infection (HAI)s in small and medium sized hospitals, less than 400 beds. METHODS: We had web based surveillance for HAIs in 27 hospitals from August to October 2010. The surveillance performed in 1-2 ICUs and 1 general ward in each hospitals by CDC definition. And for the multi-drug resistant organisms (MDROs), we reviewed all of blood culture results. RESULTS: We identified 319 HAIs among 269,436 patients days. The HAIs rate was 1.18 (CI 1.05-1.32)/1,000 patient-days. Urinary tract infection was the most common HAI (52.4%) in this study followed by pneumonia (18.9%), blood-stream infections (14.2%), surgical site infection (7.9%), and others (6.6%). There were 76.5% of device associated infections in UTI, 46.7% in BSI, and 18.3% in pneumonia. The rate of HAIs in ICU was higher than that of in general ward (4.6 vs 0.9/1,000 patient-days). However, the indwelling catheter associated urinary tract infection rate was lower in ICU (2.6 vs 4.4/1,000 device days). There were no significant differences in central line-associated blood stream infection rate (1.5 vs 1.8) and ventilator-associated pneumonia rate (3.0 vs 0.0). The common microorganisms found in HAIs were Escherichia coli (19.8%), Staphylococcus aureus (13.1%), and Pseudomonas aeruginosa (12.7%). Moreover, 90.9% of S. aureus were resistant to methicillin, and 38.2% of P. aeruginosa and 44.4% of Acinetobacter baumannii were resistant to imipenem. Total of 66 MDROs were isolated from blood culture and the result shows that the MRSA was 84.6% (56 case), carbapenmen-resistant Acinetobacter spp. was 10.6% (7 case), and vancomycin-resistant enterococci was 4.6% (3 case). CONCLUSION: The characteristics of HAIs in small and medium sized hospitals will be contributed to the decision making of governance policy for infection control and to provide comparable data for these hospitals.
Acinetobacter ; Acinetobacter baumannii ; Catheters, Indwelling ; Centers for Disease Control and Prevention (U.S.) ; Decision Making ; Escherichia coli ; Humans ; Imipenem ; Infection Control ; Methicillin ; Methicillin-Resistant Staphylococcus aureus ; Patients' Rooms ; Pneumonia ; Pneumonia, Ventilator-Associated ; Pseudomonas aeruginosa ; Rivers ; Staphylococcus aureus ; Urinary Tract Infections

PURPOSE: To evaluate the efficacy and safety of the combination of cataract surgery and intravitreal bevacizumab injection in patients with cataract and diabetic macular edema. METHODS: Patients received an intravitreal injection of bevacizumab(1.25 mg) combined with phacoemulsification and implantation of a posterior chamber intraocular lens. Best corrected visual acuity (BCVA, LogMAR) and, central macular thickness (CMT) were measured using OCT at baseline and at one week, one, three, and six months after surgery, and adverse events were recorded. RESULTS: The mean baseline LogMAR BCVA was 0.84+/-0.50 and mean CMT was 337.1+/-57.50 micrometer. At one week, one, three, and six months after surgery, the mean BCVAs were 0.52+/-0.40, 0.51+/-0.42, 0.52+/-0.34, and 0.46+/-0.37, and the mean CMTs were 356.4+/-86.44 micrometer, 338.8+/-138.4 micrometer, 349.0+/-122.9 micrometer, and 334.2+/-100.4 micrometer, respectively. No adverse events associated with cataract surgery or intravitreal bevacizumab injection were observed. CONCLUSIONS: The short-term results from the present study suggest the combination of cataract surgery and intravitreal bevacizumab injection are safe and effective for the prevention of macular edema aggravation for one month, but has little effect on prevention of macular edema aggravation three months after surgery for diabetic macular edema patients.
Antibodies, Monoclonal, Humanized ; Cataract ; Humans ; Intravitreal Injections ; Lenses, Intraocular ; Macular Edema ; Phacoemulsification ; Visual Acuity ; Bevacizumab

PURPOSE: To review the management of posterior segment metallic intraocular foreign bodies (IOFB) and to compare the use of an external approach using a large electromagnet and an internal approach using vitrectomy and its tools for their removal. METHODS: A retrospective review was performed on 49 eyes of 49 patients who underwent surgical removal of metallic IOFBs with either an internal or an external approach at a single institution between January 2003 and December 2006. We divided 49 eyes into two groups based on the type of approach: 26 external (n=26) and 23 internal (n=23). Visual acuity and the presence of any complications occurring with the two approaches were the main outcome measures studied. RESULTS: Thirty of 49 eyes (61%) showed improvements in visual acuity. When we compared patients treated with an external versus an internal approach, we found no statistically significant difference in regard to visual outcome. Preoperative vitreous hemorrhage and endophthalmitis were more common in the internal approach group. A trend toward a higher rate of reoperation was more common in the external approach group, but they were not statistically significant. Postoperative complications found to be significantly different between the two groups were the rate of postoperative endophthalmitis and retinal detachment, which were more common in the external approach group. CONCLUSIONS: Surgical removal of metallic IOFBs results in significant visual improvement regardless of the approach method. The internal approach by vitrectomy is recommended as the first choice in preoperative conditions such as severe cataracts, vitreous hemorrhage and endophthalmitis, as well as in groups at high risk for postoperative endophalmitis and retinal detachment.
Cataract ; Endophthalmitis ; Eye ; Foreign Bodies ; Humans ; Magnets ; Outcome Assessment (Health Care) ; Postoperative Complications ; Reoperation ; Retinal Detachment ; Retrospective Studies ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage

PURPOSE: To compare the incidence of complications and the outcome of phacoemulsification surgery in patients with and without previous vitrectomy. METHODS: We retrospectively investigated 60 patients in a study group that received phacoemulsification with posterior chamber IOL implantation (PC-IOL) in the vitrectomized eye and 60 patients in a control group that received only phacoemulsification with PC-IOL implantation from January 2003 to December 2007. The interval from PPV to cataract extraction, sex, age, type of cataract, intraoperative and postoperative complications, pre- and postoperative refraction were reviewed. RESULTS: The most common indication of pars plana vitrectomy was diabetic retinopathy. Nucleosclerosis was the most common type of cataract. The most common intraoperative complication was posterior capsular rupture, but there was no statistical significance when compared with the control group (p=0.116). In addition, the most common postoperative complication was posterior capsular opacity. After phacoemulsification, the rate at which a BCVA of 0.5 or better was obtained was lower in the study group than the control group. The spread between actual and expected refraction showed no statistically significant difference when compared with the control group (p=0.309). CONCLUSIONS: Experienced surgeons can safely perform phacoemulsification and PC-IOL implantation in previously vitrectomized eyes. However, the outcome of visual acuity is limited by vitreoretinal pathology that requires vitrectomy.
Cataract ; Cataract Extraction ; Diabetic Retinopathy ; Eye ; Humans ; Incidence ; Intraoperative Complications ; Phacoemulsification ; Postoperative Complications ; Retrospective Studies ; Rupture ; Visual Acuity ; Vitrectomy

PURPOSE: To identify the clinical manifestations and risk factors for poor visual outcome, as well as antibiotic susceptibility of isolates in bacterial keratitis. METHODS: A total of 128 eyes in 128 patients with bacterial keratitis, who were diagnosed by smears and cultures from January 2000 to December 2007 were reviewed retrospectively. Sex, age, previous ocular disease, trauma history, pre-treatment duration, previous ocular surgery, clinical manifestation, causative bacteria, pre- and post-treatment visual acuity, and treatment results were evaluated. An initial univariate and multivariate logistic regression analysis was performed to identify and select the main prognostic factors. The antibiotic susceptibility was evaluated in 2 consecutive 4-year periods. RESULTS: The mean age of the 128 patients was 59.0+/-18.2 years; 67 (52.3%) patients were male. The most common risk factor was ocular trauma (40.6%). The most prevalent isolate was coagulase-negative Staphylococcus (43.7%). Large size (p < 0.001) and previous ocular disease (p < 0.001) were significant prognostic factors in the multivariate logistic regression model. Resistance of cefazolin and aminoglycoside antibiotics that were commonly used as a combination therapy increased over the 8 years, but there was no significant difference in the 2 time periods tested (all p > 0.05). Among the fluoroquinolone antibiotics, susceptibility of ciprofloxacin was 75.7%. CONCLUSIONS: In patients with bacterial keratitis, a large ulcer size and the presence of previous ocular disease were risk factors for poor visual outcome. Gentamicin, cefazolin, and ciprofloxacin should be avoided as primary monotherapy for bacterial keratitis.
Anti-Bacterial Agents ; Bacteria ; Cefazolin ; Ciprofloxacin ; Eye ; Gentamicins ; Humans ; Keratitis ; Logistic Models ; Male ; Retrospective Studies ; Risk Factors ; Staphylococcus ; Ulcer ; Visual Acuity