OBJECTIVE

To identify retinal lesions through ultrawide field (UWF) images and correlate their presence, size, location, and number with the immunologic status of individuals living with human immunodeficiency virus (HIV)

This retrospective study reviewed UWF retinal images and CD4 counts of adult patients diagnosed with HIV. ImageJ software was used to annotate lesions and create heat maps. The distribution of lesions (hemorrhages, cotton wool spots, cytomegalovirus [CMV] lesions) was evaluated across 3 retinal zones: posterior pole, mid-periphery and far periphery. Statistical analyses were conducted using SAS version 9.4.

The study included 44 eyes of 23 male HIV patients, with a mean age of 35 ± 9.3 years, and a mean CD4 count of 74 ± 145 cells/mm³. HIV retinopathy was present in 24 (54.5%) eyes and CMV retinitis in 6 (13.6%) eyes. Among eyes with HIV-related findings (N=30), 8 (26.7%) had hemorrhages, 19 (63.3%) had cotton wool spots, and 7 (23.3%) had both. Eyes with HIV retinopathy had significantly low CD4 counts (17 vs. 25 cells/mm³, p=0.0398), and eyes with CMV retinitis had even lower CD4 counts (9 vs. 22 cells/mm³, p=0.0133). Lesion annotations showed that the mean area covered by hemorrhages was 0.47 mm² (97.9% in the posterior pole), cotton wool spots was 0.73 mm² (96.0% in the posterior pole), and CMV lesions was 22.89 mm² (37.9% in the posterior pole, 35.9% in the mid-periphery, and 26.1% in the far periphery).

HIV retinopathy findings are predominantly located within 10 mm of the foveal center, while over 62% of CMV lesions are present outside this zone. This highlights the importance of evaluating the retinal periphery in high-risk patients. Regular monitoring using UWF imaging is recommended for HIV-infected individuals with low CD4 counts, to detect vision-threatening conditions like CMV retinitis.

PURPOSE: To report a case of retinal toxicity after an intravitreal ganciclovir injection to treat acute retinal necrosis in an eye filled with silicone oil.CASE SUMMARY: A 56-year-old male presented with ocular pain and visual loss in his right eye. His best-corrected visual acuity was 20/25, inflammatory cells in the anterior chamber, multiple retinitis lesions and retinal vessel occlusions in the peripheral retina and vitreous opacity were showed. Acute retinal necrosis was suspected, anterior chamber polymerase chain reaction (PCR) test was done. Aciclovir 2,400 mg/day intravenously and ganciclovir 2.0 mg were administered by intravitreal injection. After 4 days, retinitis was worsened and PCR test was positive for varicella zoster virus. Ganciclovir intravitreal injections were increased twice a week. After 16 days, retinal detachment occurred, so scleral encircling, vitrectomy, laser photocoagulation, and silicone oil tamponade were conducted. Ganciclovir 1.0 mg was injected at the end of surgery. The patient's visual acuity decreased to hand motion, and multiple crystal deposits with multiple retinal hemorrhages were observed in the right eye the next day. Visual acuity did not recover and optical coherent tomography showed that the macula was thinned.CONCLUSIONS: Visual loss seemed to be related with the retinal toxicity of ganciclovir. The increased local concentration due to the silicone oil tamponade is thought to have caused the toxicity.
Acyclovir ; Anterior Chamber ; Ganciclovir ; Hand ; Herpesvirus 3, Human ; Humans ; Intravitreal Injections ; Light Coagulation ; Male ; Middle Aged ; Polymerase Chain Reaction ; Retina ; Retinal Detachment ; Retinal Hemorrhage ; Retinal Necrosis Syndrome, Acute ; Retinal Vessels ; Retinaldehyde ; Retinitis ; Silicon ; Silicones ; Visual Acuity ; Vitrectomy

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 investigate the risk factors of diabetic nephropathy in patients with diabetic retinopathy requiring panretinal photocoagulation (PRP) and the visual prognosis. METHODS: A retrospective review of electronic medical records was conducted at Seoul St. Mary's Hospital, comprising 103 patients with type 2 diabetes mellitus and diabetic retinopathy who underwent PRP from 1996 to 2005. Patients with type 1 diabetes mellitus, non-diabetic renal disease, non-diabetic retinal disease, visually significant ocular disease, high-risk proliferative diabetic retinopathy, and advanced diabetic retinopathy were excluded. The patients were divided into three groups: no nephropathy (group 1, n = 45), microalbuminuria (group 2, n = 16), and advanced nephropathy (group 3, n = 42). Duration of diagnosis of retinopathy and nephropathy, glycosylated hemoglobin, visual acuity, complications, and treatment history were investigated. RESULTS: The mean glycosylated hemoglobin of group 3 (8.4 ± 1.2) was higher than that of group 1 (7.7 ± 1.0) or group 2 (7.7 ± 1.0) (p = 0.04). Mean interval from PRP to diagnosis of nephropathy was 8.8 ± 6.0 years in group 2 and 8.7 ± 4.9 years in group 3. The significant decrease in visual acuity in group 3 (28 eyes, 35.9%) was significantly higher than that in group 1 (15 eyes, 18.1%, p = 0.01) or group 2 (6 eyes, 20.7%, p = 0.03). Only vitreous hemorrhage showed a significantly higher incidence in groups 2 and 3 than in group 1 (p = 0.02). Multivariate regression analysis revealed that female sex and lower glycosylated hemoglobin were significantly associated with a protective effect on development of nephropathy. CONCLUSIONS: In the clinical setting, many patients with PRP-requiring diabetic retinopathy develop nephropathy an average of 8 to 9 years after PRP. Male sex and higher glycosylated hemoglobin could be risk factors of nephropathy.
Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Diabetic Nephropathies ; Diabetic Retinopathy ; Diagnosis ; Electronic Health Records ; Female ; Hemoglobin A, Glycosylated ; Humans ; Incidence ; Light Coagulation ; Male ; Prognosis ; Retinal Diseases ; Retrospective Studies ; Risk Factors ; Seoul ; Visual Acuity ; Vitreous Hemorrhage

PURPOSE: To investigate the changes of visual acuity and central macular thickness (CMT) in patients with diabetic retinopathy (DR) receiving long-term hemodialysis (HD). METHODS: From January 1, 2008, to December 31, 2018, the medical records of patients who were diagnosed with DR receiving HD three times a week for ≥18 months due to chronic kidney disease (CKD) were analyzed. Among them, patients diagnosed with DR 6 months before the start of HD were included. Patients with vitreous hemorrhage (VH) affecting visual acuity (VA), other retinal diseases, and cataract surgery after HD were excluded. The VA and CMT before HD and at 1, 3, 6, 12, and 18 months after HD were analyzed. RESULTS: Of the 222 eyes of 111 patients who were diagnosed with DR and received HD for CKD due to diabetes, 174 eyes with DR diagnosed after starting HD were excluded. Ten eyes with VH before starting HD, two eyes with epiretinal membrane, and four eyes with cataract surgery after starting HD were also excluded. Thirty-two eyes of 18 patients were included. The mean age of the patients was 53.71 ± 9.25 years. Twenty-four males and eight female patients were included in the study. The mean logMAR VA improved significantly from 0.36 ± 0.28 before starting HD to 0.26 ± 0.27 at 18 months after starting HD (p = 0.002). The mean CMT was significantly decreased from 307.12 ± 89.52 µm before starting HD to 279.71 ± 61.75 µm at 12 months after starting HD (p = 0.02). CONCLUSIONS: In patients with DR who underwent long-term HD, CMT decreased and VA improved, when compared with these parameters before HD.
Cataract ; Diabetic Retinopathy ; Epiretinal Membrane ; Female ; Humans ; Macular Edema ; Male ; Medical Records ; Renal Dialysis ; Renal Insufficiency, Chronic ; Retinal Diseases ; Visual Acuity ; Vitreous Hemorrhage

PURPOSE: Although there are significant risks, retrobulbar anesthesia is commonly used for eye surgery. We report two cases of Purtscher-like retinopathy, a rare complication. CASE SUMMARY: (Case 1) A 76-year-old female visited our hospital because of decreased vision. She underwent right cataract surgery with retrobulbar anesthesia. After 7 days, she had decreased visual acuity (VA) and a constricted visual field. Multiple white spots and cotton wool spots around the optic nerve and post pole, macular edema (ME), and subretinal fluid (SRF) were found using a fundus examination. A non-perfusion area and staining of the vascular wall were seen using fluorescence angiography. Although carotid arterial angiography, thrombolysis, and intravenous injection of high-dose steroids were performed, the ME and SRF persisted. After intravitreal aflibercept was injected twice (2-month interval), the ME and SRF decreased and remained stable. (Case 2) A 61-year-old male underwent left cataract surgery with retrobulbar anesthesia. After anesthesia, the VA of the left eye was 10 cm finger count. The fundus examination showed multiple hemorrhage blots and retinal hemorrhages, and hyperfluorescence around the optic nerve and post pole; vascular wall staining revealed a Purtscher-like retinopathy. Left carotid arterial angiography, thrombolysis, and intravenous injection of high-dose steroids were then performed. After treatment, the VA of the left eye, ME, and SRF were improved at the 4-month follow-up. CONCLUSIONS: We report rare complications of retrobulbar anesthesia, with active and timely treatment having a positive impact on the visual prognosis.
Aged ; Anesthesia ; Angiography ; Cataract ; Dental Caries ; Female ; Fingers ; Fluorescein Angiography ; Follow-Up Studies ; Hemorrhage ; Humans ; Injections, Intravenous ; Macular Edema ; Male ; Middle Aged ; Optic Nerve ; Prognosis ; Retinal Hemorrhage ; Steroids ; Subretinal Fluid ; Visual Acuity ; Visual Fields ; Wool

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: To report a case of orbital apex syndrome (OAS) combined with central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) following blunt trauma. CASE SUMMARY: A 4-year-old female visited the hospital following a traffic accident. She was admitted because of multiple fractures of the skull and pneumocephalus. On day 5, she was referred to us with decreased visual acuity in her right eye. Her initial visual acuity was hand motions in the right eye and 0.8 in the left eye. The right eye showed a dilated pupil, ptosis, and total ophthalmoplegia, and the left eye showed limited abduction. A fundus examination revealed multiple retinal hemorrhages, tortuous veins, and an edematous white retina with a cherry-red spot in the right eye. Brain magnetic resonance imaging revealed an entrapped right optic nerve because of bony fragments in the orbital apex. The patient was diagnosed with OAS accompanied by CRAO and CRVO in the right eye, and with traumatic abducens nerve palsy in the left eye. After 6 months, the visual acuity was hand motions, and the fundus examination showed absorbed retinal hemorrhages, pale discs, and general retinal thinning of the right eye. Ptosis of the right eye and extraocular muscle movement of both eyes were improved. CONCLUSIONS: Combined CRAO and CRVO following trauma is very rare and is even more rarely associated with OAS. It is important for clinicians to be aware of the potential for central retinal vessel occlusions and OAS in cases of blunt ocular trauma.
Abducens Nerve Diseases ; Accidents, Traffic ; Brain ; Child, Preschool ; Female ; Fractures, Multiple ; Hand ; Humans ; Magnetic Resonance Imaging ; Ophthalmoplegia ; Optic Nerve ; Orbit ; Pneumocephalus ; Pupil ; Retina ; Retinal Artery Occlusion ; Retinal Artery ; Retinal Hemorrhage ; Retinal Vein ; Retinal Vessels ; Retinaldehyde ; Skull ; Veins ; Visual Acuity

PURPOSE: To report a case of retinopathy in a patient with chronically resistant idiopathic thrombocytopenic purpura (ITP) associated with a poor prognosis. CASE SUMMARY: A 52-year-old female presented with a complaint of decreased visual acuity, which was 0.63 in both eyes. The patient had received a splenectomy, was receiving systemic treatment for chronic ITP, and had a history of diabetes mellitus and hypertension. Multiple retinal and subretinal hemorrhages and Roth spots were found on fundus examination. Fluorescein angiography revealed microaneurysms and hemorrhages in all four quadrants of the retina. The patient's platelet count was 38,000/µL. The patient was diagnosed with non-proliferative diabetic retinopathy and ITP-associated retinopathy, and underwent panretinal photocoagulation. Sudden visual loss was noted 4 months later, at which time the patient's visual acuity was 0.1 in both eyes, and her platelet count was 7,000/µL. For 2 years, the patient's platelet count was not controlled, and remained between 12,000–19,000/µL despite active medical treatment. Macular edema did not improve with intravitreal triamcinolone, dexamethasone, and bevacizumab. Retinal hemorrhages were not absorbed and visual acuity decreased to light perception in the right eye and counting fingers in the left eye. CONCLUSIONS: ITP-associated retinopathy was associated with a poor prognosis when the systemic disease was not controlled.
Bevacizumab ; Dexamethasone ; Diabetes Mellitus ; Diabetic Retinopathy ; Female ; Fingers ; Fluorescein Angiography ; Hemorrhage ; Humans ; Hypertension ; Light Coagulation ; Macular Edema ; Middle Aged ; Platelet Count ; Prognosis ; Purpura, Thrombocytopenic, Idiopathic ; Retina ; Retinal Hemorrhage ; Retinaldehyde ; Splenectomy ; Triamcinolone ; Visual Acuity