Abstract: Cataract surgery is one of the most common ophthalmologic procedures and has a high rate of success. Postoperative complaints of dry eye symptoms may occur, including ocular soreness, pain, burning sensation and foreign body sensation [1-3]. Studies suggest that cataract surgery can lead to the presentation of dry eye signs and symptoms by a change in the ocular surface environment or there may be a pre-existing condition not recognized by the patient or physician [1-3]. Cyclosporine 0.05% is a topical immunomodulatory compound with inflammatory properties that have been demonstrated to have a benefit in the treatment of dry eye [4-6]. Many clinical studies revealed good results in topical cyclosporine 0.05% treatment for dry eye syndrome through the modulation of ocular surface inflammation. However, no studies have been published regarding the use of cyclosporine 0.05% to control dry eye symptoms or to treat inflammatory ocular surface as a consequence of cataract surgery. The efficacy and safety of cyclosporine 0.05% has been demonstrated for dry eye syndrome. In our study, we evaluated the effectiveness of the treatment of newly developed dry eye after cataract surgery by analyzing changes in Schirmer test I (ST-I), tear film break-up time (tBUT), corneal temperature, and symptom severity scores before and after cyclosporine 0.05% use (Restasis; Allergan Inc., Irvine, CA, USA).

Abstract: Methods: The medical records of 43 patients with an idiopathic ERM that underwent vitrectomy and ERM removal between July 2007 and April 2010 were reviewed. The patients were divided into two groups: triamcinolone-assisted simple ERM peeling only (group A, n = 23) and triamcinolone-assisted ERM peeling followed by ICG staining and peeling of the remaining internal ILM (group B, n = 20). Results: No difference was found between the two groups in terms of visual acuity, macular thickness, P1 amplitude or implicit time on multifocal-electroretinogram (mfERG) at six and 12 months postoperatively. In group B, ICG staining after ERM peeling demonstrated that the ILM had been removed together with the ERM in 12 eyes (60%), and all 12 eyes showed punctate retinal hemorrhages during ERM peeling. There was no recurrence of an ERM in either group. Conclusions: Additional procedures involving ICG staining and ILM peeling during ERM surgery do not appear to have an additive effect on the clinical outcomes in terms of visual acuity, retinal function based on mfERG, or recurrence rate.

Abstract: Involutional entropion leads to corneal epithelial problems, ocular irritation, and blepharospasm in an elderly population. Without treatment, entropion can cause corneal ulceration, microbial keratitis, visual loss, or even eye loss. Various factors contribute to the inward rotation of the eyelid margin, including thinning of the tarsal plate, atrophy of orbital fat tissue, horizontal lid laxity, vertical lid laxity secondary to dehiscence, disinsertion or laxity of lower lid retractors, and overriding of the preseptal orbicularis onto the pretarsal orbicularis secondary to the loosening of adhesion of the orbicularis and skin to the tarsal plate [1-3]. Many surgical procedures have been described for the management of entropion, and varying success rates have been reported, even for the same surgical techniques performed by different authors [4-14]. Because of the multifactorial nature of the disease, no entirely satisfactory surgical technique has yet been reported [4]. Due to a lack of comparative studies, the best surgical technique remains controversial. We performed the combined procedure, comprised of a lateral tarsal strip (LTS), retractor tightening, and everting sutures (ES), on 45 eyes with involutional entropion and compared the results with those of 31 eyes which had undergone the Wies procedure.

Abstract: Purpose: To determine the prevalence of thyroid eye disease among dysthyroid Korean patients and to analyze the relationship between demographic data, lifestyle risk factors, and status of thyroid disease and thyroid eye disease. Methods: All dysthyroid patients who visited endocrinology clinics in 24 general hospitals in Korea during a chosen one-week period were enrolled in this cross-sectional study. Data were collected during an interviewer-administered questionnaire and chart review. Demographic data, lifestyle risk factors, and status of thyroid disease variables were analyzed as risk factors using multivariable regression models to identify independent associations with thyroid eye disease. Results: A total of 1,632 dysthyroid patients were included (1,301 females [79.7%] and 331 males [20.3%]). Two hundred eighty-three of these patients (17.3%) had thyroid eye disease. Multiple logistic regression analyses revealed that female gender, young age, Graves’ disease, dermopathy, anti-thyroid medication treatment, and radioiodine treatment were independent risk factors for thyroid eye disease. Conclusions: The lower prevalence of thyroid eye disease in dysthyroid Korean patients and the influence of gender on risk factors in this study are novel findings compared to studies performed involving Europeans. Although the risk factors for thyroid eye disease are understood in part, a more in-depth comparative study of gender and ethnic groups is needed to fully understand the biological significance of the demographic factors.

Abstract: Penetrating keratoplasty (PKP) has been the definitive surgical treatment option for keratoconus for the past few decades [1-3]. Recently, deep anterior lamellar keratoplasty (DALK) has been considered an acceptable alternative treatment because it has the advantage of eliminating the risk of endothelial rejection and intraocular complications [4,5]. Considering that most patients with keratoconus are young, and that postoperative best-corrected visual acuity (BCVA) is expected to be acceptable, the objective of keratoconus surgery is not only to achieve a clear graft, but also to minimize refractive errors that can last a lifetime. In PKP, oversized donor grafts tend to result in postoperative myopia that is significantly greater than that resulting from same-size donor grafts [6-8]. Despite the concern of flat graft-related complications, such as wound leakage and hyperopic residual refraction [9], numerous attempts have been made to reduce postoperative myopia by using either same-size or smaller donor grafts [10-12]. Few studies have directly compared same-size grafting in DALK with same-size grafting in PKP. Recent studies have reported that DALK with same-size donor grafts results in relatively low myopia [13-15]; however, the optical effect of same-size grafting in DALK for keratoconus is still undetermined. The aim of this study was to compare clinical outcomes, focusing particularly on optical changes, between DALK and PKP with same-size grafts in patients with keratoconus.

Abstract: Advances in spectral domain optical coherence tomography (SD-OCT) and enhanced depth-imaging techniques have allowed for measurement of the deep layers of the retina and choroid [1]. Recently, some studies have been published regarding the configuration of choroidal thickness on the macula and the peripapillary area of normal controls, as well as those of patients with various macular and optic disc diseases [1-6]. However, the method used to measure choroidal thickness has varied among studies and could be dependent on the observers and the location of the scans used to measure choroidal thickness. In previous optical coherence tomography (OCT) studies, line scanning was used to investigate choroidal thickness around the optic disc [4,5]. In these studies, choroidal thickness was determined between two boundaries set by the observers. Although they found excellent inter-observer agreement for the measurements, variations between observers were still present. Choroidal thickness was determined at a specific point on the line scans of the optic disc, rather than the entire line scan. More time and effort may be needed to manually measure the thickness of the entire area of the line scan. They topographically related choroidal thickness with those of the overlying retina or retinal nerve fiber layer (RNFL). While a relationship between choroidal thickness and overlying RNFL thickness was found, the comparison was not based on the normative database of peripapillary RNFL thickness. In contrast to measurements taken from line scans of the optic disc, measurement of peripapillary RNFL thickness by OCT circle scan has been widely used for the diagnosis and monitoring of optic disc disorders, such as glaucoma and anterior ischemic optic neuropathy [7-10]. The circle scan mode of current SD-OCT systems provides automatic retinal and RNFL thickness information at 12 sectors around the optic disc. The OCT viewer program provides a normative database for peripapillary RNFL thickness. Measurement of choroidal thickness by circle scan for RNFL thickness could be useful to investigate the relationship between choroidal thickness and the overlying RNFL thickness. In the current SD-OCT scanning protocol for peripapillary circle scans, each image is scanned several times and averaged to improve the signal-to-noise ratio. In the averaged circle scan image, the choroid could be better delineated than in those images obtained without averaging. In the current study, we evaluated the method used to measure choroidal thickness on peripapillary images for RNFL analysis using an OCT viewer program.

Abstract: Vascular endothelial growth factor (VEGF) plays a key role in vasculogenesis and the pathologic neovascularization (NV) associated with eye disease [1-4]. Although anti-VEGF therapy for ocular disease has been principally directed at retinal vascular conditions, it is widely accepted that anti-VEGF therapy is also effective when used to treat corneal NV, with results from animal and human studies supporting this suggestion [5-11]. Targeted corneal NV has been induced in animals by chemical burning, suturing, application of a VEGF/bFBF pellet, or limbal injury, and anti-VEGF therapy has been used to treat human eyes with corneal NV associated with chemical burns, graft-versus-host disease, herpetic keratitis, limbal damage, ocular cicatricial pemphigoid, use of penetrating keratoplasty, and Stevens-Johnson syndrome. Various reports show that the use of anti-VEGF therapy is not restricted by disease etiology. Currently, popular anti-VEGF agents include bevacizumab (Avastin; Genentech Inc., San Francisco, CA, USA; Roche, Basel, Switzerland) and ranibizumab (Lucentis; Genentech Inc.). These materials are humanized monoclonal antibodies directed toward VEGF. No Food and Drug Administration (FDA)-approved drug is yet available for treatment of corneal NV. Most prior studies have investigated the effects of bevacizumab rather than ranibizumab. However, it is notable that ranibizumab is the only agent approved by the FDA for intraocular use even though it is costly, especially considering that anti-VEGF therapy may need to be repeated [12,13]. Therefore, comparative work using both bevacizumab and ranibizumab therapy is necessary. In the present study, we evaluated the short term effects of bevacizumab and ranibizumab on the regression of corneal NV and compared these effects in patients with corneal NV caused by various ocular surface disorders.

Abstract: Cone dystrophy is an inherited retinal disorder characterized by the loss of cone cells- the photoreceptors responsible for central and color vision. The most common symptoms are progressive vision loss, poor color vision, and sensitivity to bright light. Full-field electroretinography (ERG), which demonstrates reduced single-flash and flicker responses in the photopic condition and a normal response in the scotopic condition, is the gold-standard test. The widespread adoption of high-resolution spectral-domain optical coherence tomography (SD-OCT) enabled investigators to demonstrate structural abnormalities in the retinal layers and their correlations with functional status in various retinal diseases, such as acute zonal occult outer retinopathy-complex diseases [1], epiretinal membrane [2], macular hole [3,4], and retinitis pigmentosa [5]. Several investigators have studied the retinal structural changes in cone dystrophy patients using SD-OCT. Birch et al. [6] evaluated the effects of selective rod or cone cell loss on SD-OCT findings in patients with cone dystrophy or retinitis pigmentosa and reported that the normalized product of the thickness of the outer nuclear layer (ONL) and the summed thickness of the photoreceptor outer segment (OS) and retinal pigment epithelium (RPE) was proportional to the visual field sensitivity. Hood et al. [7] studied patients with cone dystrophy or achromatopsia and showed that the intensity of the inner segment ellipsoid (ISe) band, previously called the inner segment (IS)-OS junction band, of the photoreceptor seen by SD-OCT was lower in patients with diminished cone function than in healthy controls. Each of those studies included only 6 patients with cone dystrophy, which is a relatively small number, and did not show the morphologic SD-OCT features of the outer retina in detail. In the present study, we attempted to analyze the structural changes in the outer retinas of 15 patients with cone dystrophy using SD-OCT and related the structural changes to the functional and electrophysiologic findings.

Abstract: A substantial proportion of patients with macula-off rhegmatogenous retinal detachment (RRD) experience poor visual recovery even after successful re-attachment surgery. Many studies have shown associations between structural changes and final visual outcomes in macula-off retinal detachment (RD) patients who have undergone successful retinal re-attachment surgery. Preoperative visual acuity and duration of macular detachment are known to influence post-surgery visual outcomes [1-3]. More recent studies using optical coherence tomography (OCT) showed that preoperative OCT findings, such as a greater height of the detached fovea, and the presence of an intraretinal cyst, intraretinal separation (IRS), and/or outer layer undulation (OLU), were associated with postoperative visual acuity [1,4,5]. Postoperative factors relevant to visual outcome include the presence of cystic macular edema, development of an epiretinal membrane (ERM), presence of retinal folds, subretinal retinal pigment epithelium migration, and the persistence of subretinal fluid [1,6]. With development of spectral-domain OCT (SD-OCT), the postoperative microstructure of a re-attached macula can now be studied in greater detail. Wakabayashi et al. found that the junction between the photoreceptor inner and outer segments (IS/OS) and that of the external limiting membrane (ELM) were both closely (and positively) correlated with postoperative visual acuity [7]. Although several studies have documented the relationship between preoperative and postoperative OCT findings on the one hand and pre and postoperative visual outcomes on the other, few reports have compared preoperative OCT findings with postoperative OCT data. In the present study, we used SD-OCT to evaluate preoperative and postoperative factors affecting the anatomic and functional outcomes of retinal re-attachment surgery after maculaoff RRD repair, focusing on the correlation between preoperative microstructure of the fovea and postoperative photoreceptor integrity.

Abstract: Purpose: Long-term use of topical medication is needed for glaucoma treatment. One of the most commonly prescribed classes of hypotensive agents are prostaglandin analogs (PGs) used as both first-line monotherapy; as well as in combination therapy with other hypotensive agents. Several side effects of eye drops can be caused by preservatives. The purpose of this study was to evaluate the effects of PGs with varying concentrations of benzalkonium chloride (BAC), alternative preservatives, or no preservatives on human conjunctival fibroblast cells. Methods: Primary human conjunctival fibroblast cells were used in these experiments. Cells were exposed to the fol lowing drugs: BAC at different concentrations, bimatoprost 0.01% (with BAC 0.02%), latanoprost 0.005% (with BAC 0.02%), tafluprost 0.0015% with/without 0.001% BAC and travoprost 0.004% (with 0.001% Polyquad) for 15 and 30 minutes. Cell cytotoxicity was evaluated by phase-contrast microscopy to monitor morphological changes of cells, Counting Kit-8 (CCK-8) assay to cell viability, and fluorescent activated cell sorting (FACS) analysis to measure apoptosis. Results: BAC caused cell shrinkage and detachment from the plate in a dose-dependent manner. Morphological changes were observed in cells treated with bimatoprost 0.01% and latanoprost 0.005%. However, mild cell shrinkage was noted in cells treated with tafluprost 0.0015%, while a non-toxic effect was noted with travoprost 0.004% and preservative-free tafluprost 0.0015%. CCK-8 assay and FACS analysis showed all groups had a significantly decreased cell viability and higher apoptosis rate compared with the control group. However, travoprost 0.004% and preservative-free tafluprost 0.0015% showed lower cytotoxicity and apoptosis rate than other drugs. Conclusions: This in vitro study revealed that BAC-induced cytotoxicity is dose-dependent, although it is important to emphasize that the clinical significance of toxicity differences observed among the different PGs formulations has not yet been firmly established. Alternatively preserved or preservative-free glaucoma medications seem to be a reasonable and viable alternative to those preserved with BAC.

Abstract: We report an unusual case of unilateral frosted branch angiitis associated with Behcet's disease, including a review of previously reported cases. A 39-year-old male with history of recurrent oral and genital ulcers presented with visual loss in his left eye. Fundus findings demonstrated occlusive retinal vasculitis resembling acute frosted branch angiitis. Laboratory examinations including viral markers revealed no abnormal findings except positive HLA-B51. The patient was treated with systemic steroid and cyclosporine. Six months after presentation, new oral ulcers and pseudofolliculitis appeared, and he was diagnosed with Behcet's disease following rheumatology consultation. During follow-up, there was no change in visual acuity of hand movement, and disc neovascularization developed even after complete panretinal photocoagulation. Ocular manifestations of Behcet's disease can present as unilateral frosted branch angiitis, and may consecutively involve in both eyes. Early immunosuppressive treatment is recommended.

Abstract: Keratoconus is a progressive non-inflammatory disease of the cornea characterized by central stromal thinning that causes apical protrusion, irregular astigmatism, and impaired vision. [1,2] Although the cause of keratoconus remains unknown, many factors, including biomechanical and molecular factors and mechanical trauma, have been considered to contribute to the occurrence or progression of the disease. One controversial aspect of previous studies is that different criteria for progression have been used, including clinical progression to penetrating keratoplasty [3-12]. Previous studies have defined the progression of keratoconus with diverse parameters, from the clinical progression that necessitates penetrating keratoplasty to several topographic indices. As corneal topography provides the most effective means of evaluating morphologic change in patients with keratoconus, several topographic parameters obtained by Orbscan II (Bausch & Lomb, Claremont, CA, USA) have been used [7,10,11], but there has been no consensus on which parameters should be used for evaluation. Furthermore, the number of parameters used in earlier studies was so limited that diverse topographic changes indicating progression of keratoconus could not be used to determine progression. We aimed to include many of the Orbscan II parameters used in previous studies to determine keratoconus progression. We investigated changes in eight such parameters among patients followed-up for more than 2 years. Subsequently, prognostic factor analysis was used to explore factors associated with topographic progression of keratoconus.

Abstract: Nasal packing after dacryocystorhinostomy (DCR) is an optional procedure to prevent nasal bleeding [1,2]. Although improvements in surgical technique have reduced the need for this practice, nasal packing is still needed more for Asians than for Caucasians due to anatomical differences. Compared to Caucasians, Asians have a thicker lacrimal bone, a thicker frontal process of the maxilla, and a narrower nasal passage [3-5]. In addition, the proportion of the maxilla to the lacrimal bone in the lacrimal sac fossa is greater than in Caucasians [4]. Such anatomical differences make osteotomy more difficult and prone to nasal bleeding in Asians when performing DCR. Postoperative nasal bleeding is unpleasant for patients and can be severe in certain cases [2,6]. It can potentially affect the mucosal healing process and can cause fibrosis and induce scarring at the newly formed rhinostomy site, all of which could result in an impairment of ostial patency [7]. Therefore, the minimization of intra- and postoperative bleeding is important to consider in an attempt to achieve successful surgical results. The effects of nasal packing are not limited to hemostasis, as it also directly affects wound healing [8-14]. In the field of endoscopic sinus surgery, a number of papers have investigated whether or not nasal packing, both in general and in regard to the type used, affected nasal mucosal re-epitheliazation, fibrous tissue proliferation, granulation, and synechiae formation [8,11-13]. More recently, the effects of nasal packing materials after DCR have started to draw attention [10], but there are no well-established conclusions due to the scarcity of reports. Furthermore, the lack of standardization in the measurement of DCR surgical outcomes makes it difficult to compare and interpret the results of previous studies [15]. Packing materials are broadly divided into non-absorbable and absorbable materials. Non-absorbable materials include Vaseline gauze strips and Merocel, which inhibit bleeding through a compression mechanism [8]. Absorbable materials such as Gelfoam [1,9] and MeroGel [10] have been reported to be successful as packing materials after DCR. Nasopore, a bioresorbable dressing for the nasal cavity, is composed of fully synthetic biodegradable, fragmentable foam that absorbs fluids while supporting and providing pressure against the surrounding tissue. As such, it could potentially prevent undesired postoperative adhesions [13]. To investigate the effects of postoperative packing with Nasopore, we placed Nasopore at the anastomosis site of newly formed anterior mucosal flaps. Patients who had their nasal cavities packed with Merocel packing were recruited as a control group. Merocel, due to its non-absorbable character, is supposed to be removed within 2 to 3 days after its application. We investigated the degree of postoperative re-bleeding and the level of patient discomfort and compared the anatomical and functional success rate 3 months post-surgery between Nasopore and Merocel. To our knowledge, this is the first report to investigate the effect of Nasopore on the surgical outcome of DCR.

Abstract: The human adenovirus (HAdV) family consists of 57 known types, which fall into seven species, A to G [1-3]. The most common external ocular viral infections are caused by several HAdV types. In particular, adenoviral conjunctivitis is known to be the major cause of acute infections associated with community and nosocomial epidemics. A recent study revealed that novel types, such as HAdV type 54, are the major types responsible for inducing adenoviral conjunctivitis in Japan [4]. However, no specific anti-adenoviral agent has been established for the treatment of adenoviral infection. There is a need for new antiviral therapeutics with potent activity against HAdV and a favorable therapeutic index. In innate immunity, antimicrobial peptides have an important role in the self-protection of the body surface. Their spectrum of activity includes Gram-positive and Gram-negative bacteria, as well as fungi and certain viruses [5,6]. They exist in insects, plants, and mammals and have an important role in innate immunity. Cathelicidins are peptide antibiotics that are receiving increased attention. These peptides contain a highly conserved signal sequence and pro-region (cathelin) but show substantial heterogeneity in the C-terminal domain that encodes the mature peptide, which can range in size from 12 to 80 amino acids or more [7]. Human cationic antimicrobial protein (hCAP)-18 is a linear, α-helical peptide that consists of a conserved prosequence called the cathelin-like domain. The C-terminal 37-amino-acid mature peptide encoded by this gene is termed LL-37. The presence of LL-37 was first reported in myeloid cells, and it is also found on body surfaces, such as the skin, respiratory epithelium, and ocular surface [8-12]. The antimicrobial activities of LL-37 have been reported [13], including a statistically significant inhibitory effect in reducing viral titer of HAdV type 19 (HAdV19) [12]. However, a viral plaque method based on the conventional cytopathic effect (CPE) assay was used in a previous report [12]. In the present study, quantitative polymerase chain reaction (PCR) methods were used to investigate the in vitro anti-adenoviral activity of LL-37 in several adenovirus types capable of inducing keratoconjunctivitis.

Abstract: Purpose To investigate the analgesic effect and incidence of postoperative nausea and vomiting (PONV) between the opioid fentanyl and the non-steroidal anti-inflammatory drug ketorolac in patients who underwent eye amputation surgery

Abstract: Optical coherence tomography (OCT) is the most common imaging tool used to examine the macula, as it is the only instrument that provides direct visualization of the in vivo retinal structure [1]. The traditional OCT technique involves time-domain OCT (TD-OCT) [2-5], where retinal depth information is obtained with a reference arm after longitudinal translation over time [6]. Good reproducibility of retinal thickness measurements by Stratus OCT (Carl Zeiss Meditec, Dublin, CA, USA) has been demonstrated [7,8]. However, since the time-domain method samples only one point at a time, a relatively long period of time is needed to obtain A- and B-scan images, resulting in lower image resolution compared to spectral domain-OCT (SD-OCT) [9]. Newer SD-OCT offers improved image resolution of less than 5 to 7 µm, dramatically faster acquisition speeds (18,000 to 40,000 A-scans/second), and detailed views of the intraretinal microstructures as well as three-dimensional images of the retina [8,10-12]. In SD-OCT, light beams returning from the sample and reference paths are combined at the detector, and then a spectrometer resolves the interference signals throughout the depth of each A-scan without varying the length of the reference path [9]. This allows the acquisition of retinal images approximately 50 times faster with SD-OCT than with TD-OCT [13] and results in improved resolution of the B-scan images and better delineation of the retinal layers, including the retinal pigment epithelium (RPE)-Bruch's membrane choriocapillaris complex [14,15]. Numerous studies and clinical trials have used foveal thickness (FT) values that are measured by Stratus OCT for the determination of macular lesions, such as those in exudative age-related macular degeneration (AMD) and macular edema, and for the assessment of treatment response and guidelines for retreatment [16-18]. In order to use the known treatment and follow-up guidelines that are proposed in numerous clinical studies, it is essential to match the thickness parameters of different OCT devices, especially between TD-OCT and SD-OCT. A recent study on normal subjects demonstrated that Spectralis OCT (Heidelberg Engineering Inc., Heidelberg, Germany) obtained retinal thickness measurements that were increased by approximately 65 to 70 µm compared to Stratus OCT measurements [19]. However, studies have reported discrepancies in FT values measured by TD-OCT and SD-OCT in eyes with various retinal diseases [20-23]. Stratus OCT defines retinal thickness from the internal limiting membrane (ILM) to the complex of the inner and outer segments (IS/OS) of the photoreceptor junction and RPE layer, while Spectralis OCT selects images from the ILM to the RPE-Bruch's membrane choriocapillaris complex [12]. Because the segmentation algorithm for each OCT instrument is different, the measured FT should also be different for each. One study using Stratus and Spectralis OCT reported that the mean foveal thickness differences (FTD) in eyes with choroidal neovascularization (CNV) and AMD were significantly greater than those in normal eyes and in other retinal diseases [20]. Conversion equations and their application to TD-OCT and SD-OCT for the examination of eyes with diabetic macular edema [22] and with AMD [23] have been previously reported. However, no studies have compared the distribution of FTDs in various retinal diseases or constructed conversion formulas that predict TD-OCT-measured FT on the basis of SD-OCT-measured FT across different retinal diseases. In addition, the association between the amount of FTD and the disease severity indicated by FT has not yet been investigated. The purpose of this study was to compare the measurement values obtained using TD-OCT (Stratus) and SD-OCT (Spectralis) devices in normal and diseased retinas in order to construct conversion formulas in normal eyes and eyes with various retinal diseases. These conversion formulas must be as accurate as possible in order to predict the FT provided by Stratus OCT on the basis of data obtained using Spectralis OCT. The accuracy of these formulas must also be verified to ensure minimal errors in clinical application.

Abstract: To report keratitis with Elizabethkingia meningoseptica, which occurred in a healthy patient after wearing contact lenses for 6 months. A 24-year-old male patient visited our hospital with ocular pain. This patient had a history of wearing soft contact lenses for 6 months, about 10 hours per day. At initial presentation, slit lamp examination showed corneal stromal infiltrations and small epithelial defect. Microbiological examinations were performed from corneal scrapings, contact lenses, and the contact lens case and solution. The culture results from contact lenses, contact lens case and solution were all positive for Elizabethkingia meningoseptica. Thus, we could confirm that the direct cause of keratitis was contamination of the contact lenses. The patient was treated with 0.3% gatifloxacin. After treatment, the corneal epithelial defect was completely healed, and a slight residual subepithelial corneal opacity was observed. We diagnosed keratitis with Elizabethkingia meningoseptica in a healthy young male wearing soft contact lenses. We conclude that Elizabethkingia meningoseptica should be considered as a rare but potential pathogen for lens-related keratitis in a healthy host.

Abstract: Purpose: To evaluate the correlation of the distance Krimsky test and the alternate prism cover test (APCT) for the distance deviation in patients with horizontal strabismus. Methods: Forty patients with horizontal strabismus (20 esotropia and 20 exotropia) were included in this study. Patients with a variable angle of deviation, vertical angle over 5 prism diopters, impaired binocular vision, or poor cooperation were excluded. We instructed the patient to look a target 6 meters away, and applied a prism over the patient’s dominant eye while flashing a light source 33 centimeters from the middle of both eyebrows. When the corneal light reflexes were located on the center of each cornea, we measured the angle of deviation. We defined this method as ‘distance Krimsky test,’ and the angle measured by this method was compared with the conventional Krimsky test and APCT at distance. We analyzed the accuracy and intraand inter-observer reliability. Results: The angle of strabismus measured by the distance Krimsky test showed a significant agreement and correlation with the deviation angle measured by the APCT. We elicited the correlation gradient between the angle measured by the distance Krimsky test and the APCT. In addition, the distance Krimsky test showed significant intra- and inter-observer reliabilities. Conclusions: The distance Krimsky test is expected to be more useful than the Krimsky test in measuring the distance angle of deviation for patients with strabismus in whom it is difficult to measure the angle of deviation using the APCT. The distance Krimsky test can be an accurate and useful test through the improvement of proficiency of examiners and the establishment of individualized normative data.

Abstract: Methods: Thirty-one patients with acquired unilateral SOP were recruited for this study. The torsional angle of each patient was assessed via one objective method (fundus photography) and two subjective methods (double Maddox rod test and major amblyoscope). The patient population was divided into two groups (concordance group, n = 19 and discordance group, n = 12) according to the correspondence between the hypertropic eye (paralytic eye) and the more extorted eye (non-fixating eye), which was evaluated by fundus photography. Results: The mean value of objective torsion was 5.09° ± 3.84°. The subjective excyclotorsion degrees were 5.18° ± 4.11° and 3.65° ± 1.93° as measured by double Maddox rod test and major amblyoscope, respectively. Hypertropia and the excyclotorsional angle did not differ significantly between the groups (p = 0.257). Although no correlation was found in the discordance group, the concordance group showed a significant and positive correlation between hypertropia and excyclotorsion (p = 0.011). Conclusions: Torsional deviation was not related to hypertropia. However, in the concordance patients in whom the hypertropic eye showed excyclotorsion, a significant positive correlation was found between hypertropia and excyclotorsion.

Abstract: In patients with diabetes mellitus, diabetic macular edema is one of the major causes of loss of visual acuity. Macular edema occurs as result of increased permeability of retinal capillary vessels due to disruption of the blood-retinal barrier. With the common use of optical coherence tomography (OCT), the morphology of diabetic macular edema has been classified into various types [1,2]. Otani et al. [2] reported that macular edema can be classified into diffuse, cystoid, serous, and mixed types. Serous-type macular edema occurs in 15% to 30% of diabetic macular edema cases [3]. To date, however, a limited number of studies have been conducted to determine the basis for the differences in morphologic type of diabetic macular edema. In particular, the relationship between diabetic macular edema type and non-ocular factors has not been studied. Thus, we studied the relationship between renal dysfunction and the morphologic changes in macular edema in patients with diabetes mellitus.

Abstract: Orbital lymphomas account for less than 1% of all non-Hodgkin's lymphomas in the body. The mucosa-associated lymphoid tissue (MALT) type of orbital lymphoma involving the ocular adnexa is the most common histological type [1-4]. Several studies have reported that MALT lymphomas constitute a higher proportion of primary ocular adnexal lymphomas (OAL) in Korea and Japan (80% to 98%) than in western countries (50% to 78%) [3,4] and that ocular adnexal MALT lymphoma (OAML) develops at a younger age at initial presentation in the Korean population [3]. Radiotherapy is known as a treatment modality with a high local control rate for primary OAML [1,2]. Despite its high local control rate, many studies have reported that radiation can induce complications such as cataracts, keratitis, dry eye syndrome, and retinopathy [1,5-8]. The lens of the eye is a radiosensitive structure [7]. It is well established that ionizing radiation exposure damages the dividing cells of the crystalline lens; differentiation and migration of the damaged cells to the posterior pole leads to posterior lens opacifications [7,9]. Cataracts can be induced by a single dose of 36 Gy [4-6,10-12]. While many studies have reported possible radiation doses for cataract formation [4-6,8], and some have reported that radiation can induce subcapsular opacification of the lens [9,13], we have limited detailed information about the characteristics of radiation-induced cataracts in OAML. Although OAML is an indolent, non-fatal disease, and the overall survival rate of OAL is high (92.8%) [3], patients have the possibilities of surgery for radiation-induced cataract at a relatively young age [3,4]. Cataract operations can be stressful, especially in younger patients, and can decrease the quality of life due to early loss of accommodation and near vision. To our knowledge, there are no detailed reports on the characteristics of frontline radiotherapy associated cataracts. It would be helpful to analyze frontline radiotherapy associated cataracts in detail for OAML patients to maintain better quality of life. The present retrospective study assessed the clinical characteristics of radiotherapy associated cataracts in eight consecutive patients with a diagnosis of OAML treated at Seoul St. Mary's Hospital. In particular, we investigated fractionation and total radiation dose, grade of lens opacification, intervals from first radiation exposure to cataract surgery, visual acuity changes before and after radiotherapy, cataract surgery techniques, final visual outcomes, and surgical complications.

Abstract: Purpose To comparatively analyze the methodological efficacy of the polymerase chain reaction (PCR) assay for herpes simplex virus 1 (HSV) detection in tears.

Abstract: Infectious sources have been repeatedly reported as the pathogenesis in various cancers. The relationship between the human papilloma virus (HPV) and cervical cancer is a well-proven example. Especially among the various types of HPV, certain types appear to be more oncogenic and are therefore named high-risk HPV [1]. Helicobacter pylori and gastric cancer is another widely-known example of infective agent-associated cancer [2]. Based on such findings, microorganism or viral eradication has been suggested as a treatment for such cancers. In the same vein, interest has arisen in the association of ocular tumors and infections. The association between ocular adnexal mucosa-associated lymphoid tissue lymphoma and Chlamydia psittaci infection has been well documented [3]. Among ocular tumors, retinoblastoma (RBL) is the most common primary ocular malignancy in children, accounting for approximately 3% of the tumors occurring in people under 15 years of age and leading to 9,000 deaths annually worldwide [4]. RBL is known to be more prevalent in areas of low hygiene and socioeconomic status, such as South America, Africa and Southeast Asia, raising the possibility of infection as a factor in its development. Several studies have recently reported the association of HPV with RBL. Anand et al. [5] demonstrated the presence of HPV in a subset of patients with RBL. Shetty et al. [6] also suggested that infection of HPV-16/-18 may interfere with the cell regulatory process and lead to development of RBL in the Indian population. However, contradictory results were reported by Gillison et al. [7] that revealed no relationship between HPV and RBL in North American populations. These discrepant results may suggest geographic differences in the prevalence and etiology of retinoblastoma and HPV infection. To date, no reports are available with respect to the East Asian population. In this study, we analyzed 54 retinoblastoma patients who underwent enucleation to demonstrate the association with HPV infection in the Korean population.

Abstract: Here, we present the case of a patient with bilateral choroidal metastases with extraocular extension in one eye. Metastasis of papillary thyroid carcinoma to the uvea is extremely rare, with only 6 patients reported in the literature. A 62-year-old man with a prior history of papillary thyroid carcinoma suffered the rapid loss of vision in his right eye. He had neovascular glaucoma, total retinal detachment, and a solitary choroidal mass. A month later, his left visual acuity also decreased because of a small macular choroidal mass. The right eye was enucleated and a nodular lesion over the sclera representing extraocular extension was observed. This tumor and the intraocular lesion were composed of papillary excrescences and cystic spaces and stained positively for thyroid transcription factor 1 and thyroglobulin, all confirming the diagnosis of metastatic papillary thyroid carcinoma. The tumor in the left eye was successfully treated with diode laser transpupillary thermotherapy. The patient expired within a month as a result of widespread pulmonary metastases. Papillary thyroid carcinoma may metastasize to the uvea bilaterally, cause rapid visual function loss, erode the sclera, and may extend outside the globe similar to choroidal melanoma. This aggressive ocular involvement was associated with a dismal prognosis in our patient.

Abstract: Methods: This study measured the visual acuity, manifest refraction and optical quality before and one day, one week, one month, and three months after laser vision correction. Optical quality parameters including the modulation transfer function, Strehl ratio and intraocular scattering were evaluated with a double-pass system. Results: This study included 51 eyes that underwent LASIK and 57 that underwent PRK. The optical quality three months post-surgery did not differ significantly between these laser vision correction techniques. Furthermore, the preoperative and postoperative optical quality did not differ significantly in either group. Optical quality recovered within one week after LASIK but took between one and three months to recover after PRK. The optical quality of patients in the PRK group seemed to recover slightly more slowly than their uncorrected distance visual acuity. Conclusions: Optical quality recovers to the preoperative level after laser vision correction, so laser vision correction is efficacious for correcting myopia. The double-pass system is a useful tool for clinical assessment of optical quality.

Abstract: A pair of 19-year-old female identical twins was referred to our hospital with progressive visual loss. They exhibited bilateral chorioretinal atrophy involving the midperiphery on fundoscopy and fluorescein angiography. Bilateral visual field constriction was noted on dynamic Goldmann perimetry, and a markedly impaired response was observed on both photopic and scotopic electroretinograms. Cystoid macular edema was identified in both eyes on optical coherence tomography. Plasma levels of ornithine were elevated. Based on these observations, the patients were diagnosed with gyrate atrophy of the choroid and retina. The clinical diagnosis was confirmed by mutation analysis of the ornithine-δ-aminotransferase (OAT) gene. Patients were treated with a pyridoxine supplement (300 mg/day) and an arginine-restricted diet to lower plasma levels of ornithine, which were successfully reduced without progression of chorioretinal atrophy for 15 months. Our report describes the first case of gyrate atrophy in the Korean population diagnosed by OAT gene analysis and treated with vitamin B6 dietary supplementation.

Abstract: Branch retinal artery occlusion (BRAO) and branch retinal vein occlusion (BRVO) rarely cause neovascular glaucoma (NVG). A 58-year-old woman with hypertension and type 2 diabetic mellitus complained of progressive visual loss in her right eye for the previous 3 months. At initial examination, visual acuity was 20 / 63 in the right eye. Angle neovascularization was observed and the intraocular pressure (IOP) was 30 mmHg in her right eye. Fundus examination and fluorescein angiography showed BRAO combined with BRVO. We immediately injected intravitreal and intracameral bevacizumab in her right eye. The next day, we performed scatter photocoagulation in the nonperfusion area. One month later, visual acuity was 20 / 20 in her right eye and the IOP was 17 mmHg with one topical antiglaucoma agent. The neovascularization had regressed completely. We report a case of unilateral NVG which was caused by BRAO with concomitant BRVO and advise close ophthalmic examination of the iris and angle in BRVO with BRAO.

Abstract: We report a case of CMV corneal endotheliitis that was treated with intravitreal ganciclovir injection. A 56-year-old man who has suffered from uveitis was referred to our clinic due to corneal endothelial abnormality. Slit lamp examination showed a localized sectoral corneal edema and linear keratic precipitates along the boundary of edema. In spite of treatment with oral steroid and acyclovir, the disease progressed and two new coin-like lesions were developed. After topical ganciclovir and intavitreal injection of ganciclovir, the corneal lesions disappeared.

Abstract: Purpose To evaluate the efficacy of vitrectomy combined with intravitreal injection of triamcinolone acetonide (IVTA) and macular laser photocoagulation for the treatment of nontractional diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy.