PURPOSE: To evaluate the long-term outcomes of optic disc pit maculopathy after vitrectomy. METHODS: We evaluated retrospectively the medical records of eight patients with macular retinal detachment or retinoschisis who underwent vitrectomy due to optic disc pit maculopathy. The best-corrected visual acuity and optical coherence tomography findings were analyzed after surgery. RESULTS: Eight eyes of eight patients (two male and six female) were enrolled. The mean best-corrected visual acuity was 0.76 log MAR, the mean age was 42.8, and the mean follow-up period was 56 months (range: 8–120 months). At baseline, retinoschisis was observed in all eight eyes. Six eyes had serous retinal detachment of the macula. Vitrectomy for a complete posterior vitreous detachment was performed. Additional internal limiting membrane peeling and tamponade were performed in six and four eyes, respectively. After surgery, serous retinal detachment was gone in all eyes (100%) at a mean of 22.8 months (range: 18 days–60 months). Three of eight eyes (37.5%) showed the disappearance of retinoschisis at a mean of 6.8 months (range: 1.7–21 months), but the remaining patients still had retinoschisis at the final visit. Ocular complications were full-thickness macular hole and iatrogenic retinal detachment in each case. The final corrected visual acuity improved to 0.29 logMAR. CONCLUSIONS: Vitrectomy is an effective treatment for patients with optic disc pit maculopathy. It achieved anatomical and visual improvements over a long period of time. However, retinoschisis due to inner retinal fluid remained in many patients.
Follow-Up Studies ; Humans ; Male ; Medical Records ; Membranes ; Retinal Detachment ; Retinal Perforations ; Retinaldehyde ; Retinoschisis ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy ; Vitreous Detachment

PURPOSE: A case of bilateral rhegmatogenous retinal detachment is reported after pazopanib treatment of a patient with breast angiosarcoma. CASE SUMMARY: A 53-year-old female presented with bleeding in a right breast mass prior to an emergency room visit. She was diagnosed with metastatic breast angiosarcoma after a breast mass biopsy. She was treated with paclitaxel and radiation therapy. Systemic pazopanib treatment was added to treat lung metastasis. After 3 weeks, she felt sudden floaters in her right eye. In her fundus examination, there was vitreous hemorrhage, but no retinal detachment was noted. Five weeks later, she visited the clinic for a bilateral temporal visual field defect. A fundus examination showed bilateral retinal detachments with superonasal retinal tears. Both the patient and her family did not want surgery for her systemic condition because of her terminal cancer. CONCLUSIONS: Retinal detachment has been reported as a rare complication after systemic pazopanib treatment, but there has been no previous report in the Republic of Korea, therefore this is the first case of bilateral retinal detachments after systemic pazopanib treatment.
Biopsy ; Breast ; Emergency Service, Hospital ; Female ; Hemangiosarcoma ; Hemorrhage ; Humans ; Lung ; Middle Aged ; Neoplasm Metastasis ; Paclitaxel ; Republic of Korea ; Retinal Detachment ; Retinal Perforations ; Retinaldehyde ; Visual Fields ; Vitreous Hemorrhage

BACKGROUND: To investigate the effects of dipeptidyl peptidase-4 inhibitor (DPP4i) as add-on medications to metformin on progression of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus, compared with sulfonylurea (SU) or thiazolidinedione (TZD). METHODS: We identified 4,447 patients with DPP4i, 6,136 with SU, and 617 with TZD in addition to metformin therapy from the database of Korean National Health Insurance Service between January 2013 and December 2015. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) for DR progression. The progression of DR was defined by the procedure code of panretinal photocoagulation, intravitreal injection or vitrectomy; or the addition of diagnostic code of vitreous hemorrhage, retinal detachment, or neovascular glaucoma. RESULTS: The age and sex-adjusted HR of DR progression was 0.74 for DPP4i add-on group compared with SU add-on group (95% confidence interval [CI], 0.62 to 0.89). This lower risk of DR progression remained significant after additional adjustments for comorbidities, duration of metformin therapy, intravitreal injections and calendar index year (HR, 0.80; 95% CI, 0.66 to 0.97). CONCLUSION: This population-based cohort study showed that the use of DPP4i as add-on therapy to metformin did not increase the risk of DR progression compared to SU.
Cohort Studies ; Comorbidity ; Diabetes Mellitus, Type 2 ; Diabetic Retinopathy ; Dipeptidyl-Peptidase IV Inhibitors ; Glaucoma, Neovascular ; Humans ; Hypoglycemic Agents ; Intravitreal Injections ; Light Coagulation ; Metformin ; National Health Programs ; Retinal Detachment ; Vitrectomy ; Vitreous Hemorrhage

PURPOSE: To evaluate the availability of ultra-wide field fundus photography based on eye steering technique to diagnose retinal breaks in patients with symptomatic posterior vitreous detachment (PVD). METHODS: The medical records of patients with symptomatic PVD were reviewed. Retinal breaks were independently identified using four eye steering capture images of ultra-wide field fundus photographs. The sensitivity and specificity of eye steering capture imaging for diagnosing retinal breaks were calculated. RESULTS: A total of 94 eyes of 94 patients were included. Using fundus examination after pupil dilatation, retinal breaks were diagnosed in 42 (45%) eyes. The sensitivity of the eye steering capture imaging was 98% (95% confidence interval [CI]: 88–100%), and the specificity was 98% (95% CI: 90–100%). Of the 58 retinal tears, 28 (97%) involving the superior quadrant, 10 (100%) involving the inferior quadrant, 6 (100%) involving the nasal quadrant, and 13 (100%) involving the temporal quadrant were identified using eye steering capture images. CONCLUSIONS: Ultra-wide field fundus photography based on eye steering technique was useful for diagnosing retinal breaks in patients with symptomatic PVD. However, eye steering photography could not adequately replace the fundus examination after pupil dilatation in all cases.
Dilatation ; Humans ; Medical Records ; Photography ; Pupil ; Retinal Perforations ; Sensitivity and Specificity ; Vitreous Detachment

PURPOSE: To investigate the clinical outcomes of combined vitrectomy and intrascleral fixation of a new posterior chamber intraocular lens (PC IOL) as a treatment for IOL dislocation. METHODS: We conducted a retrospective interventional study at our medical facility from January 2015 to January 2017. Posteriorly dislocated IOLs were removed with pars plana vitrectomy. Two intrascleral tunnels, 2.0 mm in length, were created 1.5 mm to the limbus at 6 and 12 o'clock positions. Both haptics of new foldable acrylic 3-piece IOLs were inserted into the tunnel until the IOL was secured in a central position. We analyzed the preexisting ocular condition, visual acuity (VA), and refractive error preoperatively and postoperatively, and recorded postoperative complications. RESULTS: Forty-nine patients (50 eyes) were enrolled in the study. The mean follow-up period was 12.8 ± 6.6 months. A best-corrected VA of 6/12 or better was achieved in 43 eyes (86%). The mean VA significantly improved from 0.32 logarithm of the minimum angle of resolution (logMAR) at baseline to 0.18 logMAR at last follow-up (p = 0.03). The refractive status after intrascleral fixation of the PC IOL revealed a mean hyperopic shift of +1.09 ± 1.28 diopters from the predicted spherical equivalent. Postoperative vitreous hemorrhages occurred in six cases and were cleared without visual compromise. Cystoid macular edema was well-controlled by topical nonsteroidal anti-inflammatory drugs (NSAID) medications in two cases. In two cases, IOL dislocation recurred and required re-operation. There were no serious adverse events of suture-related complications, retinal detachment, corneal compromise, or endophthalmitis in any of the patients. CONCLUSIONS: Our data revealed that use of combined vitrectomy and intrascleral fixation of PC IOLs is a safe and efficient technique to correct IOL dislocation. We observed good visual outcomes with only minor complications.
Dislocations ; Endophthalmitis ; Follow-Up Studies ; Humans ; Lenses, Intraocular ; Macular Edema ; Postoperative Complications ; Refractive Errors ; Retinal Detachment ; Retrospective Studies ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage

BACKGROUND: To analyze the results of court rulings about medical litigations related to cataract surgery in Korea. METHODS: We collected 50 anonymized judgements regarding cataract surgery between 2000 and 2016 and analyzed the reasons for the medical litigations, the court rulings, the reasons for compensation, and the amount claimed and finally awarded. RESULTS: Forty-eight litigations (96%) resulted from errors in treatment, and the reasons were as follows: endophthalmitis, dissatisfaction of visual outcome or ocular discomfort, bullous keratopathy or corneal opacity, retinal detachment, glaucoma or vitreous hemorrhage due to the progression of an underlying diabetic retinopathy, and others in order. Two litigations (4%) arose due to errors in diagnosis. Among the 50 final cases, 21 litigations (42%) were decided in favor of the plaintiff, and 29 litigations (58%) were decided against the plaintiff and dismissed. Ten cases awarded damages to the plaintiffs because of a violation of duty of care, and 11 cases awarded damages due to a violation of informed consent. When comparing cases with errors in diagnosis to cases with errors in treatment, there was no significant difference in the relative risk of a defendant's verdict (P = 0.503). The total amount of awarded damages was KRW 439,124,496 (USD 399,204), and the average amount was KRW 20,910,690 (USD 19,010). CONCLUSION: Nearly half of the cases were decided in favor of the plaintiff due to the violation of informed consent. This study's results will be helpful in understanding the results of medical litigations regarding cataract surgery and reducing future lawsuits.
Anonyms and Pseudonyms ; Awards and Prizes ; Cataract* ; Compensation and Redress ; Corneal Opacity ; Diabetic Retinopathy ; Diagnosis ; Endophthalmitis ; Glaucoma ; Informed Consent ; Jurisprudence* ; Korea* ; Ophthalmology ; Retinal Detachment ; Vitreous Hemorrhage

PURPOSE: The purpose of this study is to investigate new prognostic factors in associated with primary anatomical failure after scleral buckling (SB) for uncomplicated rhegmatogenous retinal detachment (RRD). METHODS: The medical records of patients with uncomplicated RRD treated with SB were retrospectively reviewed. Eyes with known prognostic factors for RRD, such as fovea-on, proliferative vitreoretinopathy, pseudophakia, aphakia, multiple breaks, or media opacity, were excluded. Analysis was performed to find correlations between anatomical success and various parameters, including age. RESULTS: This study analyzed 127 eyes. Binary logistic regression analysis revealed that older age (≥35) was the sole independent prognostic factor (odds ratio, 3.5; p = 0.022). Older age was correlated with worse preoperative visual acuity (p < 0.001), shorter symptom duration (p < 0.001), presence of a large tear (p < 0.001), subretinal fluid drainage (p < 0.001), postoperative macular complications (p = 0.048), and greater visual improvement (p = 0.003). CONCLUSIONS: Older age (≥35) was an independent prognostic factor for primary anatomical failure in SB for uncomplicated RRD. The distinguished features of RRD between older and younger patients suggest that vitreous liquefaction and posterior vitreous detachment are important features associated with variation in surgical outcomes.
Aphakia ; Drainage ; Humans ; Logistic Models ; Medical Records ; Pseudophakia ; Retinal Detachment* ; Retinaldehyde* ; Retrospective Studies ; Scleral Buckling* ; Subretinal Fluid ; Tears ; Visual Acuity ; Vitreoretinopathy, Proliferative ; Vitreous Detachment

PURPOSE: In the present study, 2 cases of serous retinal detachment in patients diagnosed with proliferative diabetic retinopathy after pars plana vitrectomy are reported. CASE SUMMARY: (Case 1) A 38-year-old female diagnosed with high-risk proliferative diabetic retinopathy underwent pars plana vitrectomy and cataract surgery due to intravitreal hemorrhage. One day after the operation, fundus photograph and optical coherence tomography (OCT) revealed serous retinal detachment. After ensuring that no retinal hole was present based on fundus examination, the patient was diagnosed with serous retinal detachment and antimicrobial and steroid eye drops were applied. After 1 week, subretinal fluid disappeared. (Case 2) A 63-year-old male diagnosed with proliferative diabetic retinopathy underwent pars plana vitrectomy due to right vitreous hemorrhage. On postoperative day 1, focal subretinal fluid under the macula was observed using OCT. Intravitreal triamcinolone injection was performed during surgery and steroid eye drops were applied. Subretinal fluid collection was absorbed 5 days postoperatively. CONCLUSIONS: Two cases of serous retinal detachment that occurred postoperatively in patients with diabetic retinopathy are reported. Serous retinal detachment was resolved after several days without specific management.
Adult ; Cataract ; Diabetic Retinopathy* ; Female ; Hemorrhage ; Humans ; Male ; Middle Aged ; Ophthalmic Solutions ; Retinal Detachment* ; Retinal Perforations ; Retinaldehyde* ; Subretinal Fluid ; Tomography, Optical Coherence ; Triamcinolone ; Vitrectomy* ; Vitreous Hemorrhage

PURPOSE: To report cases of macular serous retinal detachment caused by excessive intraoperative endolaser in patients with diabetic vitreous hemorrhage. Macular serous retinal detachment was improved by systemic steroid therapy. CASE SUMMARY: A 64-year-old male (case 1) and a 67-year-old female (case 2) treated with vitrectomy and endolaser (case 1, 3,184 shots; case 2, 1,734 shots) because of diabetic vitreous hemorrhage visited our out-patient clinic with blurred vision. Best corrected visual acuity (BCVA) in case 1 was hand motion and 0.03 in case 2. Fundus examination and optical coherence tomography (OCT) revealed extensive subretinal fluid accumulation of the posterior pole. With the diagnosis of macular serous retinal detachment caused by excessive intraoperative endoaser, oral steroid (40 mg/qd, 5 days) was administered and then later reduced in case 1. In case 2, we administered intravenous high-dose steroid (250 mg/qid, 3 days). After systemic steroid therapy, BCVA was improved to 20/30 in case 1 and 20/40 in case 2 and OCT showed the subretinal fluid was resolved. CONCLUSIONS: During diabetic retinopathy surgery, excessive endolaser induced macular serous retinal detachment and systemic steroid therapy was necessary in diabetic patients. Thus, physicians should be well acquainted with this complication.
Aged ; Diabetic Retinopathy* ; Diagnosis ; Female ; Hand ; Humans ; Male ; Middle Aged ; Outpatients ; Retinal Detachment* ; Retinaldehyde* ; Subretinal Fluid ; Tomography, Optical Coherence ; Visual Acuity ; Vitrectomy ; Vitreous Hemorrhage

PURPOSE: To evaluate the ganglion cell-inner plexiform layer (GCIPL) thickness after internal limiting membrane (ILM) peeling with or without intravitreal gas injection (IVGI) or surgical induction of posterior vitreous detachment (PVD). METHODS: Eighty patients who were diagnosed with epiretinal membrane (ERM) or macular hole and who received surgical intervention were retrospectively reviewed. Forty patients were treated with ILM peeling and forty patients were treated with ERM removal, but not with ILM peeling. The patients were categorized according to ILM peeling, IVGI, and surgical induction of PVD. The GCIPL thickness was measured using optical coherence tomography, and the average and sectorial thickness of GCIPL were compared. RESULTS: The GCIPL thickness in the ILM peeling group significantly decreased (-13.80 ± 22.63 µm; p < 0.001), but was not significantly different in the ERM removal without ILM peeling group, compared with the preoperative GCIPL thickness (+1.21 ± 22.53 µm; p = 0.546). The difference was statistically significant between the two groups (p = 0.038). In the ILM peeling group, GCIPL thickness was not significantly different in the IVGI group (-17.41 ± 23.92 µm vs. -7.25 ± 19.05 µm; p = 0.109) and was significantly decreased in the surgical induction of the PVD group (-23.06 ± 23.92 µm vs. -7.25 ± 19.05 µm; p = 0.020). On sectorial analysis, reduction of the temporal GCIPL thickness was the largest and was significantly different compared with the nasal GCIPL thickness in ILM peeling group (-19.73 ± 28.55 µm vs. -7.42 ± 19.90 µm; p = 0.005). CONCLUSIONS: ILM peeling and surgical induction of PVD may damage ganglion cells. Therefore, gentle ILM peeling and surgical induction of PVD may be needed to minimize ganglion cell damage, especially when ILM peeling is performed in glaucomatous patients.
Epiretinal Membrane ; Ganglion Cysts* ; Humans ; Membranes* ; Retinal Perforations ; Retrospective Studies ; Tomography, Optical Coherence ; Vitreous Detachment