Abstract: Methods: The medical records of 120 eyes from 60 patients with congenital aniridia were retrospectively reviewed. The prevalence and clinical course of ophthalmic characteristics, systemic disease, refractive errors, and visual acuity were assessed. Prognostic factors for final visual outcomes were analyzed. Results: Aniridic keratopathy developed in 82 (69%) of 119 eyes. Macular hypoplasia was observed in 70 eyes of 35 patients (91%). Cataract was observed in 63 of 120 eyes (53%). Nystagmus was present in 41 patients (68% of 60 patients) at the initial visit but decreased in five patients (8% of 60 patients). Ocular hypertension was detected in 19 eyes (20% of 93 eyes), six (32% of 19 eyes) of which developed secondarily after cataract surgery. The mean changes in spherical equivalent and astigmatism during the follow-up period were -1.10 and 1.53 diopter, respectively. The mean final visual acuity was 1.028 logarithm of minimal angle of resolution. Nystagmus and ocular hypertension were identified as prognostic factors for poor visual outcome. Conclusions: Identification of nystagmus and ocular hypertension was important to predict final visual outcome. Based on the high rate of secondary ocular hypertension after cataract surgery, careful management is needed.

Abstract: Purpose To investigate the results of graded decompression of orbital fat and walls in Graves' orbitopathy (GO) considering the degree of proptosis reduction at surgery and preoperative computed tomography (CT) findings.

Abstract: Purpose: The purpose of this study was to evaluate whether any stage of diabetic retinopathy (DR) is associated with levels of plasma erythropoietin and other plasma parameters. Methods: It was examined a representative sample of 180 type 2 diabetes patients aged 40 to 79 years. Ophthalmic examination including a funduscopic examination, performed by an experienced ophthalmologist and the retinal finding were classified according to the grading system for diabetic retinopathy of ETDRS (Early Treatment Diabetic Retinopathy Study). It was measured the levels of plasma erythropoietin, cholesterol, triglyceride, apolipoproteins A and B, C-reactive protein, fasting blood glucose and hemoglobin A1C (HbA1C) in 88 DR patients and 92 controls without DR. Risk factors correlated with DR were compared between groups. Results: The study group of 180 patients included 72 males and 108 females. The mean age of the patients with and without DR was 57.36 ± 8.87 years and 55.33 ± 8.28 years, respectively. Of the 88 patients with DR, only 9 (10%) had proliferative DR and the rest suffered from non-proliferative DR. The mean plasma levels of erythropoietin in proliferative DR group showed a significant difference in comparison to other groups. The mean plasma levels of cholesterol, triglyceride, apolipoproteins A and B, C-reactive protein, and fasting blood glucose were not significantly different in the three groups except for HbA1C. The absolute relative risk (ARR) also showed that erythropoietin was an increasing risk for proliferative DR (ARR, 1.17; 95% confidence interval, 1.060 to 1.420; odds ratio,1.060). Conclusions: Of the factors studied, erythropoietin level showed significant increase in proliferative DR group. The stepwise raised in mean plasma erythropoietin level which demonstrates significant correlation with proliferative DR versus remaining two groups, will be an indication of its role in proliferative DR.

Abstract: A 53-year-old Asian woman was treated with hydroxychloroquine and chloroquine for lupus erythematosus. Within a few years, she noticed circle-shaped shadows in her central vision. Upon examination, the patient's visual acuity was 20 / 25 in both eyes. Humphrey visual field (HVF) testing revealed a central visual defect, and fundoscopy showed a ring-shaped area of parafoveal retinal pigment epithelium depigmentation. Fundus autofluorescence imaging showed a hypofluorescent lesion consistent with bull's eye retinopathy. Adaptive optics scanning laser ophthalmoscope (AO-SLO) revealed patch cone mosaic lesions, in which cones were missing or lost. In addition, the remaining cones consisted of asymmetrical shapes and sizes that varied in brightness. Unlike previous studies employing deformable mirrors for wavefront aberration correction, our AO-SLO approach utilized dual liquid crystal on silicon spatial light modulators. Thus, by using AO-SLO, we were able to create a photographic montage consisting of high quality images. Disrupted cone AO-SLO images were matched with visual field test results and functional deficits were associated with a precise location on the montage, which allowed correlation of histological findings with functional changes determined by HVF. We also investigated whether adaptive optics imaging was more sensitive to anatomical changes compared with spectral-domain optical coherence tomography.

Abstract: Purpose: To examine the effects of panretinal photocoagulation (PRP) using a pattern scanning laser (PASCAL) system on the retinal nerve fiber layer (RNFL) thickness in patients with diabetic retinopathy. Methods: This retrospective study included 105 eyes with diabetic retinopathy, which consisted of three groups: the PASCAL group that underwent PRP with the PASCAL method (33 eyes), the conventional group that underwent conventional PRP treatment (34 eyes), and the control group that did not receive PRP (38 eyes). The peripapillary RNFL thickness was measured by optical coherence tomography before, six months, and one year after PRP to evaluate the changes in peripapillary RNFL. Results: The RNFL thickness in the PASCAL group did not show a significant difference after six months (average 3.7 times, p = 0.15) or one year after the PRP (average 3.7 times, p = 0.086), whereas that in the conventional group decreased significantly after six months (average 3.4 times, p < 0.001) and one year after PRP (average 3.4 times, p < 0.001). Conclusions: The results of this study suggest that the PASCAL system may protect against RNFL loss by using less energy than conventional PRP.

Abstract: Bietti crystalline retinal dystrophy is a rare, inherited disorder whose hallmark is the presence of retinal crystal deposits associated with later chorioretinal degeneration. This condition may rarely be complicated by the development of cystoid macular oedema leading to rapid visual decline. Currently, treatment options for this complication of Bietti dystrophy are limited and the visual prognosis is poor. Here, we present a case of cystoid macular oedema associated with Bietti dystrophy that was successfully diagnosed using multimodal imaging techniques including optical coherence tomography and fluorescein angiography. These modalities confirmed the diagnosis of macular oedema and excluded other possible causes of oedema such as choroidal neovascularisation. In this patient, cystoid macular oedema was resolved with oral acetazolamide therapy, a treatment that has not been previously reported in this context. Acetazolamide treatment resulted in oedema resolution and improvement in visual function, and can be considered a therapeutic option for other patients with Bietti dystrophy who develop cystoid macular oedema.

Abstract: PURPOSE The 2.2-mm microincision cataract surgery and small-gauge vitrectomy system is known to result in less surgically-induced astigmatism (SIA) in comparison to conventional surgical methods. We compared the amounts of SIA after combined phacoemulsification and 23-gauge transconjunctival sutureless vitrectomy (23G-TSV) using the 2.2-mm microincision and 2.75-mm standard incision methods. METHODS We studied 59 patients (61 eyes) who underwent combined phacoemulsification and 23G-TSV from November 2008 to September 2012. Twenty-eight patients (28 eyes) underwent 2.2-mm microincision coaxial phacoemulsification, and 31 patients (33 eyes) underwent 2.75-mm standard incision phacoemulsification. SIA was evaluated using Naeser's polar method with the simulated keratometric values obtained from corneal topography. Preoperative and 1-week and 1-month postoperative KP (Naeser's polar value along the specific axis) and ΔKP values were compared between the 2.2-mm microincision and 2.75-mm standard incision groups. RESULTS One week after surgery, both groups exhibited similar amounts of SIA (-ΔKP[120], 0.40 ± 0.41 vs. 0.51 ± 0.56 diopters [D]; p = 0.390). One month after surgery, however, the amount of SIA was significantly smaller in the 2.2-mm microincision group as compared to the 2.75-mm standard incision group (-ΔKP[120], 0.31 ± 0.54 vs. 0.56 ± 0.42 D; p = 0.045). CONCLUSIONS In combined phacoemulsification with 23G-TSV, 2.2-mm microincision coaxial phacoemulsification induces less SIA than does 2.75-mm standard coaxial phacoemulsification.

Abstract: Purpose: To evaluate the characteristics and relationship between peripapillary choroidal thickness (pCT), lamina cribrosa thickness (LCT), and peripapillary outer retinal layer thickness (pORT) as determined using spectral domain optical coherence tomography (SD-OCT) enhanced depth imaging (EDI). Methods: In total, 255 participants were included (87 healthy subjects, 87 glaucoma suspects (GS), and 81 glaucoma cases). The pORT, defined as the thickness between the posterior outer plexiform layer and the retinal pigment epithelium (RPE) interface, and the pCT, between the outer margin of the RPE and the choroidal-scleral interface, were manually measured using EDI scanning of the circumpapillary retinal nerve fiber layer (RNFL). LCT was determined by EDI scanning of the optic nerve head (ONH). Baseline characteristics, including axial length (AXL) and the SD-OCT measurements of the participants, were compared among the three groups. The correlation between putative factors and pCT was determined using univariate and multivariate linear regression analyses. Results: In all three groups, both pORT and pCT were thinnest in the inferior area among the four quadrants. In the healthy group, the mean peripapillary RNFL, pORT, and LCT were significantly greater in comparison with those of the GS and glaucoma groups (p < 0.001, p < 0.038, and p < 0.001, respectively). The pCT demonstrated no significant differences among the three groups (p = 0.083). Only age and AXL were associated with pCT by multivariate analysis. Conclusions: The pCT is substantially thinner in the inferior area of the ONH. In addition, the pCT demonstrates the strongest correlation with age and AXL, but was not associated with glaucoma or LCT.

Abstract: Satisfaction of patients undergoing cataract surgery is dependent on precise predictions of refractory outcomes. Over the years, development of biometry, phacoemulsification, and intraocular lens (IOL) calculation enabled precise prediction of postoperative refractory status. To obtain accurate IOL power, a number of factors are needed. These biometries include axial length, corneal refractive power, and anterior chamber depth. Among these factors, Olsen [1] reported that axial length plays a main role in determining postoperative refraction and is responsible for 54% of the actual refractive error. Axial length error of 100 µm translates to a postoperative refraction error of 0.28 diopters (D). Until recently, axial length was measured by using applanation ultrasound technique, which involves contact with the cornea and can result in corneal epithelial injury, infection, and patient discomfort. Error due to corneal indentation, which can lead to axial lengths 0.1 to 0.3 mm shorter than those measured by the immersion technique, is also a major disadvantage of the applanation ultrasound method [2]. To overcome this limitation, a partial coherence interferometer (PCI), which is based on the principle similar to that of optical coherence tomography, was introduced. Axial length measured by this method was comparable to that of other methods in precision and repeatability. Especially considering that the method is of the non-applanation type, it has the advantage of giving the patient less discomfort and has a low interobserver error [3,4,5,6]. Commonly used PCIs in the clinical setting include the IOL Master (Carl Zeiss Meditiec, Jena, Germany) and Lenstar (Haag Steit AG, Koeniz, Switzerland). Recently, the new PCI AL-scan (Nidek, Gamagori, Japan) has been introduced and increases precision by using a 3-dimentional ocular tracking technique. By using PCI and scheimpflug imaging techniques, AL-scan made it possible to measure axial length, corneal refractive power, anterior chamber depth, central corneal thickness, white-to-white distance, and pupil size in a single sitting based on those values and automatically calculates the appropriate IOL power to be used in cataract surgery by onboard software. According to previous studies, it is known that the IOL Master and Lenstar show greater or similar accuracy compared to the conventional ultrasound techniques [3,7,8]. However, studies on the newly launched PCI, AL-scan, are lacking. Therefore, in this study we used AL-scan to measure axial length and refraction. With the obtained values, IOL power is calculated to look for the degree of error compared with the predicted value preoperatively and analyze the accuracy compared to values obtained from ultrasound.

Abstract: Tuberculosis (TB) is the single most common cause of morbidity and mortality worldwide, but it is also the most cost-effective disease to treat [1,2,3]. TB is caused by Mycobacterium tuberculosis (MTB), which causes chronic and indolent systemic illness in multiple organs of the body [4]. Most patients with TB remain symptom-free, and illness occurs in only 3% to 5% of infected people. The incidence of TB-related uveitis (TRU) in patients with intraocular inflammation varies between 0.6% and 10.5%, depending on the country [4]. Cases of TRU are generally chronic and progress slowly. As MTB requires oxygen to grow, it tends to remain in the choroid and ciliary body. However, it can be present in any part of the eye and thus, the condition presents in variable ways. TRU most commonly manifests as anterior uveitis, multifocal choroiditis, panuveitis, or vasculitis. The most accurate diagnostic tool to confirm TRU is the acid-fast smear/culture combination, followed by polymerase chain reaction of an ocular fluid sample. Unfortunately, obtaining an ocular fluid sample of sufficient volume is difficult in most cases and these tests are not highly specific. Although the current gold standard for TB diagnosis is a positive tuberculin skin test (TST) combined with appropriate clinical findings, thi s test has somewhat limited accuracy. The TST can have a high false-positive rate in Korea, which has an intermediate TB burden and a large number of Bacille Calmette-Guerin (BCG)-vaccinated individuals [2,5]. Among other diagnostic tests, the interferon-gamma release assay (IGRA) has been reported to be useful for detecting TB infections [5,6]. Kang et al. [5] showed that 95.7% of Korean subjects had received the BCG vaccine, and that 51% and 4% of subjects had a positive TST and IGRA, respectively, even though the study group had no identifiable risk factors for TB. This result indicates that IGRA is a better TB test than the TST in Korea. Interestingly, Ang et al. [7] found that IGRA was more specific than TST, and the high TST false-positive rate in BCG-vaccinated subjects favors the use of IGRA. Itty et al. [6] also suggested that IGRA is useful in detecting TRU, especially in immunocompromised or BCG-vaccinated patients. However, the IGRA has a high cost, technical limitations, and a limited ability to differentiate between active and latent TB. Although several studies have shown the usefulness of IGRA in detecting TRU, few studies have investigated which patients should be tested with IGRA. Clinical factors may affect IGRA results, including age (≥46 years) and TB history, both of which are independent risk factors for false-positive outcomes [8]. However, a recent study by Critselis et al. [9] showed that a positive IGRA result was not associated with age in children investigated for latent TB infections. The aim of the present study was to evaluate the usefulness of IGRA for diagnosing TRU in Korean patients with intraocular inflammation, and to assess the effect of clinical factors, including age, on IGRA results. Clinical factors were compared between patients with and without positive IGRA results as well as between patients with and without presumed TRU. Furthermore, positive IGRA rates were compared among subgroups created based on specific clinical factors. Lastly, associations between clinical factors and IGRA results were assessed using multiple regression analyses.

Abstract: Dear Editor, Syphilis is a sexually transmitted, systemic infection with increasing prevalence. Ocular syphilis may develop at any stage of the disease process and can involve any ocular structure [1]. Ocular syphilis mimics any type of inflammatory process without pathognomonic manifestations and often leads to misdiagnosis, resulting in permanent vision loss [1,2]. Syphilitic uveitis involving the posterior segment has been reported as several conditions [1]; however, to our knowledge, no previous study describing syphilitic outer retinitis has examined the condition by spectral-domain optical coherence tomography (SD-OCT). Herein, we report a case of syphilitic outer retinopathy, mimicking acute zonal occult outer retinopathy (AZOOR). A 59-year-old man presented with a 2-week history of blurred vision in the right eye. Visual acuity was 20 / 30 in right eye and 20 / 20 in left eye. Slit-lamp examination and fundoscopy were normal (Fig. 1A). Fundus fluorescein angiography showed no abnormality in early and late phases (Fig. 1B). However, fundus autof luorescence imaging showed hyperfluorescence around the macula, while SD-OCT revealed a diffuse disruption of the photoreceptor inner segment-outer segment (IS-OS) junction line in the macula in the right eye (Fig. 1C and 1D). Multifocal electroretinography (ERG) revealed reduced amplitudes in the centermost and inferior retinal areas which corresponded to the area of visual field defect on Humphrey visual field (HVF) perimetry, and to the area of disrupted photoreceptors at the IS-OS junction line on SD-OCT (Fig. 1E and 1F). Full-field ERGs were normal and symmetric. The patient's medical history and laboratory tests were unremarkable; serologic tests for syphilis were not performed. Fig. 1 Summary of clinical and diagnostic features. At initial visit, color fundus photography (A) and fundus f luorescein angiography (A) showed normal appearance. However, fundus autofluorescence (FAF) imaging (C) and spectral-domain optical coherence tomography ... We initially diagnosed him with AZOOR, based on acute loss of visual acuity, fundoscopy, and ERG findings [3]. The patient received 15 mg/day oral prednisolone for 1 month, which was then tapered to 10 mg/day for 2 months. Since vision improved to 20 / 25 and photoreceptor disruption was partially restored after treatment (Fig. 1G), we added oral methotrexate (15 mg/wk). However, at 5 months, vision decreased to 20 / 30, vitreous opacity developed, and photoreceptor disruption progressed on SD-OCT (Fig. 1H). At 6 months, the photoreceptor disruption worsened and his vision deteriorated to 20 / 50 (Fig. 1I). Complete serologic tests were performed, which diagnosed him as active syphilis (both the Venereal Disease Research Laboratory assay and fluorescent treponemal antibody-absorption test were positive). We diagnosed him with syphilitic outer retinopathy in right eye and discontinued immunosuppressant therapy and intramuscularly administered 2.4 million units of benzathine penicillin G three times per week. One month later, vision had improved to 20 / 30, and the disruption of photoreceptor on SD-OCT was partially restored (Fig. 1J). At 3 months after antibiotics therapy, vision had improved to 20 / 20 and SD-OCT showed complete restoration of photoreceptor function (Fig. 1K). Multifocal ERG and HVF revealed complete normalization (Fig. 1L and 1M). AZOOR is a rare disease of unknown etiology and is characterized by focal degeneration. While associated with both ocular and systemic diseases [3,4], syphilis has never been reported as mimicking AZOOR in Korea. Given the clinical presentation and the lack of syphilis as differential diagnosis, we diagnosed AZOOR without exploring other possible causes. Based on this case, we suggest that syphilitic retinitis should be considered as a differential diagnosis for AZOOR, and that meticulous serologic tests should be performed prior to a diagnosis of AZOOR. In this case, SD-OCT was helpful in the evaluation and monitoring of photoreceptor damage, and the results were correlated with visual function. Although syphilitic retinitis has increased with an increasing global incidence of syphilis [5], its pathogenesis remains controversy [2,4]. However, given the response to antibiotics therapy, our case substantiates that syphilitic retinitis occurred via direct invasion of spirochetes into the lesion, rather than by an autoimmune reaction as a result of molecular mimicry. Photoreceptor disruption completely recovered with antibiotic therapy; timely administration of systemic antibiotics is thus warranted for rescuing vision in eyes with syphilitic retinitis. Furthermore, SD-OCT accurately reflected the status of photoreceptor disruption at diagnosis, as well as efficacy of therapeutic intervention. Acute syphilitic posterior placoid chorioretinitis should be also suspected as a differential diagnosis. In our case, however, we ruled out acute syphilitic posterior placoid chorioretinitis based on normal fluorescein angiography results. In conclusion, clinical suspicion of syphilitic outer retinitis in patients presenting as AZOOR is crucial for early diagnosis and treatment. Photoreceptor evaluation using SD-OCT can be useful for diagnosis and monitoring response to treatment.

Abstract: Purpose: To investigate the biometric risk factors for corneal surface complications associated with hydrogel soft contact lens (SCL) fitting in myopic patients in Korea. Methods: This is a retrospective case-control study. The records of 124 subjects (124 eyes) who wore SCLs on a daily basis were reviewed. Thirty-one patients (31 eyes) who were diagnosed with corneal neovascularization (NV) while wearing SCLs were included in the complication group. Ninety-three age- and sex-matched patients (93 eyes) who wore SCLs, who did not have corneal NV and who visited our clinic for correction of refractive errors were included in the control group. The degree of spherical equivalent, astigmatism and corneal base curve radius (BCR) were compared in both groups. Results: Patients with NV exhibited poorer best corrected visual acuity and more myopia than controls (p = 0.008 and 0.006, respectively). In univariate analysis, highly myopic patients (-9 diopters [D] or higher) were more likely to experience NV (odds ratio [OR], 2.232; 95% confidence interval [CI], 1.602 to 3.105). High astigmatism (≥2 D) increased the risk of complications (OR, 2.717; 95% CI, 1.141 to 6.451). Steep cornea, in which BCR was <7.5 mm, also raised the risk of complications (OR, 4.000; 95% CI, 1.661 to 9.804). Flat cornea was not a risk factor for the development of NV. Conclusions: High myopia, high astigmatism, and steep cornea seemed to be risk factors in the development of corneal NV in SCL wearers.

Abstract: Results: Of all patients, dry eye level 1 was most common (47.5%), followed by level 2 (33.5%), level 3 (9.1%), and level 4 (1.1%). Topical anti-inflammatory agents were used in 70.7% of patients with dry eye level 2 and in 80.6% of patients at levels 3 and 4. Topical anti-inflammatory agents were also used in 48.7% of patients with dry eye level 1. Preservative-free artificial tears were preferred at all dry eye levels. The use of topical anti-inflammatory agents did not differ with investigator ages, but older physicians preferred preserved artificial tears more than younger ones. Physicians at referral hospitals also tended to use topical anti-inflammatory agents and preserva- tive-free artificial tears earlier, beginning at dry eye level 1, than those who worked at private eye clinics. Conclusions: Topical anti-inflammatory agents were commonly prescribed for the treatment of dry eye patients in South Korea, even from dry eye level 1. Preservative-free artificial tears were preferred at all dry eye levels. Practice styles differed somewhat depending on the ages and clinic types of physicians.

Abstract: Purpose: To investigate the relationship between higher-order aberrations (HOAs) and amblyopia treatment in children with hyperopic anisometropic amblyopia. Methods: The medical records of hyperopic amblyopia patients with both spherical anisometropia of 1.00 diopter (D) or more and astigmatic anisometropia of less than 1.00 D were reviewed retrospectively. Based on the results of the amblyopia treatment, patients were divided into two groups: treatment successes and failures. Using the degree of spherical anisometropia, subjects were categorized into mild, moderate, or severe groups. Ocular, corneal, and internal HOAs were measured using a KR-1W aberrometer at the initial visit, and at 3-month, 6-month, and 12-month follow-ups. Results: The results of the 45 (21 males and 24 females) hyperopic anisometropic amblyopia patients who completed the 12-month follow-up examinations were analyzed. The mean patient age at the initial visit was 70.3 months. In total, 28 patients (62.2%) had successful amblyopia treatments and 17 patients (37.8%) failed treatment after 12 months. Among the patient population, 24 (53.3%) had mild hyperopic anisometropia and 21 (46.7%) had moderate hyperopic anisometropia. When comparing the two groups (i.e., the success and failure groups), ocular spherical aberrations and internal spherical aberrations in the amblyopic eyes were significant ly higher in the failure group at every follow-up point. There were no significant differences in any of the HOAs between mild and moderate cases of hyperopic anisometropia at any follow-up. When the amblyopic and fellow eyes were compared between the groups there were no significant differences in any of the HOAs. Conclusions: HOAs, particularly ocular spherical aberrations and internal spherical aberrations, should be considered as reasons for failed amblyopia treatment.

Abstract: Purpose: To evaluate the changes of higher order aberrations (HOAs) before and after laser subepithelial keratomileusis (LASEK) and to analyze the influence of tear film instability on HOAs of the corneal surface after LASEK. Methods: In this cross-sectional study, 31 patients who underwent LASEK were divided into dry eye (16 patients, 32 eyes) and non-dry eye groups (15 patients, 30 eyes). Uncorrected distance visual acuity, spherical equivalent refraction, ablation depth, tear film parameters and Ocular Surface Disease Index (OSDI) questionnaire scores were evaluated in both groups. Total HOA root mean square (RMS), third-order coma, third-order trefoil and fourth-order spherical aberration (SA) of the corneal surface immediately and at 10 seconds after blinking were measured before and after surgery. Results: The total HOA RMS, coma, trefoil and SA significantly increased after LASEK compared with preoperative values in both groups. In the dry eye group, total HOA RMS, coma and trefoil significantly increased except for SA at 10 seconds after blinking compared with those measured immediately after blinking. In addition, the changes of total HOA RMS, coma and trefoil were negatively correlated with tear film breakup time (R = -0.420, -0.473 and -0.439, respectively), but positively correlated with OSDI score (R = 0.433, 0.499 and 0.532, respectively). In the non-dry eye group, there were no significant differences between HOAs measured at 10 seconds after blinking and those measured immediately after blinking. Conclusions: The HOAs including coma, trefoil and SA significantly increased after LASEK. The tear film instability in the dry eye can be associated with more deterioration of the optical quality after LASEK, due to more significant increase of total HOA RMS, coma and trefoil.

Abstract: Vascular endothelial growth factor inhibitor is an emerging therapeutic modality for various ocular diseases with neovascularization (NV) However, for corneal NV, controversy remains regarding whether bevacizumab or ranibizumab is superior A 32-year-old female diagnosed with herpetic keratoconjunctivitis with refractory corneal NV despite two previous subconjunctival and intrastromal bevacizumab injections, received two subconjunctival and intrastromal ranibizumab injections Six months postoperatively, there was significant regression of the neovascular area and vessel caliber Here, the authors report a case of improvement in corneal NV with subconjunctival and intrastromal ranibizumab injections, which was previously refractory to bevacizumab injection The findings may suggest a new prospect in treating corneal NV

Abstract: Purpose: To compare the thickness of the lamina cribrosa (LC) and vascular factors of early normal-tension glaucoma (NTG) patients with high and low intraocular pressure (IOP) that are expected to be associated with the development of glaucoma. Methods: Seventy-one Korean NTG patients with low IOP (the highest IOP 15 mmHg, 31 patients) were included in this study. The thickness of LC and vascular factors were compared. The thickness of the LC was measured using the enhanced depth imaging method with spectral domain optical coherence tomography (Heidelberg Spectralis). Results: The mean thickness of the central LC was 190.0 ± 19.2 μm in the low IOP group and 197.8 ± 23.6 μm in the high IOP group, but there was no statistical significant difference between the two groups (p > 0.05). The prevalence of self-reported Raynaud phenomenon was significantly higher in the low IOP group (33.0%) than the high IOP group (10.3%, p = 0.04). Conclusions: The laminar thickness did not significantly differ between the high and low IOP groups. However, the prevalence of Raynaud phenomenon was higher in the low IOP groups. These results suggest that the development of glaucoma with low IOP patients may be more influenced by peripheral vasospasm, such as Raynaud phenomenon, rather than laminar thickness in NTG.

Abstract: Purpose: This study compared serum vascular endothelial growth factor (VEGF) concentration between patients given the bilateral and unilateral intravitreal injections of bevacizumab. Methods: In a prospective manner, serum VEGF levels in treatment-naive patients with age-related macular degeneration who underwent bilateral or unilateral intravitreal injections of bevacizumab were investigated. After informed consent, peripheral blood was collected from in patients who underwent bilateral or unilateral intravitreal injection of bevacizumab before and 1 month after the injection. Serum VEGF levels were measured by enzyme-linked immunosorbent assay after centrifugation. In addition, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) before and 1 month after the injection were compared between each group. Results: Twenty patients received bilateral injections (40 eyes) and 20 patients received unilateral injections. The VEGF concentrations (pg/mL) before the bilateral injection were 235.75 ± 183.16 and 252.53 ± 233.52 for the unilateral injection. They were significantly reduced to 153.88 ± 113.26 and 189.42 ± 251.72 after 1 month, respectively (p = 0.037 and 0.019), which are showing no significant difference between the two groups (p = 0.771). And there were no significant intergroup difference in pre- and postoperative BCVA and CRT. Conclusions: The bilateral simultaneous intravitreal injection of bevacizumab did not differ greatly from unilateral intravitreal injection in the influence on serum VEGF levels and the therapeutic outcome.

Abstract: Branch retinal vein occlusion (BRVO) is the second most common major retinal vascular disease after diabetic retinopathy [1] Epidemiologic studies found that the prevalence of BRVO ranged from 03% [2] to 16% [3], and major risk factors for the condition were increasing age, hypertension, and co-existing cardiovascular disease [2-6] Macular edema is a major cause of visual acuity loss attributable to BRVO [7-9] The Branch Vein Occlusion Study [7] found that grid photocoagulation was effective for treatment of macular edema The Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) project showed that grid photocoagulation was the best option for standard care when used to treat macular edema secondary to BRVO [10] In recent decades, several novel treatments for BRVO have been introduced in major studies such as the BRAVO [11] and GENOVA studies [12] However, the effects of such treatments remain unclear [1,9,13] Furthermore, the cited works did not mimic the true clinical situation in that intravitreal bevacizumab injections (IVBs) were consecutively administered over a 3-month period to form a loading dose, the treatment strategy to be adopted after initial treatment failure was not considered, and lastly, no study has compared intravitreal triamcinolone acetate, bevacizumab, and drug combination injections for the treatment of macular edema secondary to BRVO In the present study, we reviewed the medical records of patients treated for visual loss caused by macular edema secondary to BRVO 1) to evaluate whether intravitreal triamcinolone acetate, bevacizumab, and a combination of triamcinolone and bevacizumab injections, with or without rescue laser therapy, improved visual acuity compared with standard care of the type administered in the SCORE study, and 2) to determine whether such treatment modalities reduced unfavorable outcomes in patients with macular edema caused by BRVO, compared with those of the SCORE study

Abstract: Visual field assessment is a core component of glaucoma diagnosis and monitoring, and the Standard Automated Perimetry (SAP) test is considered up until this moment, the gold standard of visual field assessment. Although SAP is a subjective assessment and has many pitfalls, it is being constantly used in the diagnosis of visual field loss in glaucoma. Multifocal visual evoked potential (mfVEP) is a newly introduced method used for visual field assessment objectively. Several analysis protocols have been tested to identify early visual field losses in glaucoma patients using the mfVEP technique, some were successful in detection of field defects, which were comparable to the standard SAP visual field assessment, and others were not very informative and needed more adjustment and research work. In this study, we implemented a novel analysis approach and evaluated its validity and whether it could be used effectively for early detection of visual field defects in glaucoma. OBJECTIVES: The purpose of this study is to examine the effectiveness of a new analysis method in the Multi-Focal Visual Evoked Potential (mfVEP) when it is used for the objective assessment of the visual field in glaucoma patients, compared to the gold standard technique. METHODS: 3 groups were tested in this study; normal controls (38 eyes), glaucoma patients (36 eyes) and glaucoma suspect patients (38 eyes). All subjects had a two standard Humphrey visual field HFA test 24-2 and a single mfVEP test undertaken in one session. Analysis of the mfVEP results was done using the new analysis protocol; the Hemifield Sector Analysis HSA protocol. Analysis of the HFA was done using the standard grading system. RESULTS: Analysis of mfVEP results showed that there was a statistically significant difference between the 3 groups in the mean signal to noise ratio SNR (ANOVA p<0.001 with a 95% CI). The difference between superior and inferior hemispheres in all subjects were all statistically significant in the glaucoma patient group 11/11 sectors (t-test p<0.001), partially significant 5/11 (t-test p<0.01) and no statistical difference between most sectors in normal group (only 1/11 was significant) (t-test p<0.9). sensitivity and specificity of the HAS protocol in detecting glaucoma was 97% and 86% respectively, while for glaucoma suspect were 89% and 79%. DISCUSSION: The results showed that the new analysis protocol was able to confirm already existing field defects detected by standard HFA, was able to differentiate between the 3 study groups with a clear distinction between normal and patients with suspected glaucoma; however the distinction between normal and glaucoma patients was especially clear and significant. CONCLUSION: The new HSA protocol used in the mfVEP testing can be used to detect glaucomatous visual field defects in both glaucoma and glaucoma suspect patient. Using this protocol can provide information about focal visual field differences across the horizontal midline, which can be utilized to differentiate between glaucoma and normal subjects. Sensitivity and specificity of the mfVEP test showed very promising results and correlated with other anatomical changes in glaucoma field loss.

Abstract: Purpose: To evaluate the results of levator resection in patients with myopathic ptosis. Methods: The medical records of consecutive patients who underwent levator resection surgery performed for myopathic ptosis between October 2009 and March 2013 were reviewed. Indications for surgery were ptosis obscuring the visual axis and margin-reflex distance ≤2 mm. Surgical success was defined as clear pupillary axis when the patient voluntarily opened his eye and margin-reflex distance ≥3 mm. We analyzed the effect of levator function and Bell’s phenomenon on the rates of success and corneal complication. Results: This series included six male and six female patients. Levator function was between 4 and 12 mm. We performed bilateral levator resection surgery in all patients. The mean follow-up time was 14.8 months (range, 6 to 36 months). No patient was overcorrected. Adequate lid elevation was achieved after the operation in 20 eyes. Ptosis recurred in three out of 20 eyes after adequate lid elevation was achieved. Our overall success rate was 70.8%. In three eyes with poor Bell’s phenomenon, corneal irritation and punctate epitheliopathy that required artificial eye drops and ointments developed in the early postoperative period, although symptoms resolved completely within 2 months of the resection surgery. No patients required levator recession or any other revision surgery for lagophthalmos or corneal exposure after levator resection. Conclusions: Levator resection seems to be a safe and effective procedure in myopathic patients with moderate or good Bell’s phenomenon and levator function greater than 5 mm.

Abstract: Dengue fever is a viral disease that is transmitted by mosquitoes and affects humans. In rare cases, dengue fever can cause visual impairment, which usually occurs within 1 month after contracting dengue fever and ranges from mild blurring of vision to severe blindness. Visual impairment due to dengue fever can be detected through angiography, retinography, optical coherence tomography (OCT) imaging, electroretinography, event electroencephalography (visually evoked potentials), and visual field analysis. The purpose of this study is to report changes in the eye captured using fluorescein angiography, indocyanine green, and OCT in 3 cases of dengue fever visual impairment associated with consistent visual symptoms and similar retinochoroidopathic changes. The OCT results of the three patients with dengue fever showed thinning of the outer retinal layer and disruption of the inner segment/outer segment (IS/OS) junction. While thinning of the retina outer layer is an irreversible process, disruption of IS/OS junction is reported to be reversible. Follow-up examination of individuals with dengue fever and associated visual impairment should involve the use of OCT to evaluate visual acuity and visual field changes in patients with acute choroidal ischemia.

Abstract: Purpose: To evaluate the effects of a bimatoprost/timolol fixed combination (BTFC) and a latanoprost/timolol fixed combination (LTFC) on diurnal intraocular pressure (IOP) and anterior ocular parameters in healthy subjects. Methods: We enrolled 58 healthy subjects in this prospective clinical study. Thirty subjects were treated with BTFC and 28 subjects were treated with LTFC. IOP was measured every 2 hours except from 01:00 and 05:00. Axial length, corneal curvature, and anterior chamber depth were obtained using the IOL master at baseline and 24 hours later. Adverse events were assessed by patient interview and by slit lamp examination. Results: The largest difference in IOP between treated and untreated eyes 8 hours after instillation was 1.67 mmHg in the BTFC group (p < 0.001). The largest difference in IOP between treated and untreated eyes 10 hours after instillation was 1.93 mmHg in the LTFC group (p < 0.001). For anterior ocular parameters such as axial length, corneal curvature, anterior chamber depth at baseline and 24 hours after instillation, there were no significant differences between the baseline and 24-hour values in either the BTFC or LTFC group. The most frequently occurring adverse event was conjunctival hyperemia, which was found in 33.3% (n = 10) of the BTFC group and 25.0% (n = 7) of the LTFC group (p = 0.486). Conclusions: BTFC and LTFC provided a significant reduction in IOP from baseline without changing any anterior ocular parameters. Our results provide a reference for monocular trials to assess the effect of eye drops in a clinical condition.

Abstract: Purpose: To evaluate the effect of pattern scan laser (PASCAL) photocoagulation on peripapillary retinal nerve fiber layer (RNFL) thickness, central macular thickness (CMT), and optic nerve morphology in patients with diabetic retinopathy. Methods: Subjects included 35 eyes for the PASCAL group and 49 eyes for a control group. Peripapillary RNFL thickness, cup-disc area ratio and CMT were measured before PASCAL photocoagulation and at 2 and 6 months after PASCAL photocoagulation in the PASCAL or control groups. Results: The average RNFL thickness had increased by 0.84 µm two months after and decreased by 0.4 µm six months after PASCAL photocoagulation compared to baseline, but these changes were not significant (p = 0.83, 0.39). The cup-disc area ratio was unchanged after PASCAL photocoagulation. CMT increased by 18.11 µm (p = 0.048) at two months compared to baseline thickness, and partially recovered to 11.82 µm (p = 0.11) at six months in the PASCAL group. Conclusions: PASCAL photocoagulation may not cause significant change in the peripapillary RNFL thickness, CMT, and optic nerve morphology in patients with diabetic retinopathy.

Abstract: Purpose To evaluate plasma pentraxin 3 (PTX3) in patients with retinal vein occlusion (RVO), and investigate the possibility of its role as a predictive biomarker.

Abstract: In this case series, we assessed a new technique, the intrascleral pocket procedure of transscleral fixation (TF) of the intraocular lens (IOL) in post-vitrectomized eyes. We performed the transscleral fixation of IOL in four aphakic patients who underwent pars plana vitrectomy. Two points 180° apart were marked at the limbus. A 2-mm-sized intrascleral pocket was created by lamellar dissection using a crescent blade without conjunctival dissection. A 2.8-mm clear corneal incision (CCI) was made using a keratome. Prolene sutures were exteriorized through the CCI pocket and a three-piece foldable acrylic IOL was injected via CCI and the ends of the haptics were exteriorized through the CCI. The prolene sutures for each haptic in the intrascleral pocket bed were then tied and knots were buried under scleral flaps. No patient had complaints such as conjunctival irritation, and visual acuity was almost identical to preoperative best-corrected visual acuity at day 1 postoperatively. IOLs were well placed without tilting or subluxation. They had no wound dehiscence or endophthalmitis postoperatively. The intrascleral pocket procedure of TF without the need for conjunctival dissection is a successful method for sulcus fixation in post-vitrectomized eyes predisposed to developing glaucoma.

Abstract: Purpose: The aim of this study is to investigate the clinical characteristics of patients diagnosed with refractive accommodative esotropia (RAE) whose refractive errors were gradually reduced to below +2.00 diopters (D) during follow-up but use of spectacles was still required for maintenance of good ocular alignment. Methods: We conducted a retrospective review of the medical records of patients diagnosed with RAE from 1995 to 2011. Patients were divided into 2 groups according to their ocular alignment at the last visit. Inclusion criteria were hyperopia ≥+2.00 D detected with cycloplegic refraction at the initial visit, which then became mild hyperopia (<+2.00 D) or myopia during follow-up, with more than 5 years of follow-up. Results: A total of 92 patients met the inclusion criteria. Twenty-six patients showed persistent esotropia (≥10 prism diopters [PD]) without spectacles (group A) and 66 patients showed good ocular alignment (<10 PD) without spectacles (group B) at the last visit. No statistically significant differences in the spherical equivalent of the refractive errors at the initial and last visit were observed between the two groups. A significantly lower number of positive responses on the Lang I stereotest was observed in group A (n = 1, 3.8%) compared to group B (n = 22, 33.3%) (p = 0.003). There were increasing trends toward group A with worsening stereoacuity measured by the Stereo Fly Stereotest between the two groups (p = 0.016, linear by linear association). The results of the Lang I test, Stereo Fly Stereotest, and duration between the onset of esotropia and prescribing spectacles showed a significant association with the discontinuation of spectacles in the univariate logistic analysis. Conclusions: Stereoacuity showed more significant associations than refractive errors in RAE with refractive error <+2.00 D but still required spectacles for maintenance of good ocular alignment. The prompt treatment of accommodative esotropia at the onset of esotropia is important for the discontinuation of spectacles.

Abstract: We studied three patients who developed left unilateral punctate keratitis after suffering left-sided Wallenberg Syndrome. A complex evolution occurred in two of them. In all cases, neurophysiological studies showed damage in the trigeminal sensory component at the bulbar level. Corneal involvement secondary to Wallenberg syndrome is a rare cause of unilateral superficial punctate keratitis. The loss of corneal sensitivity caused by trigeminal neuropathy leads to epithelial erosions that are frequently unobserved by the patient, resulting in a high risk of corneal-ulcer development with the possibility of superinfection. Neurophysiological studies can help to locate the anatomical level of damage at the ophthalmic branch of the trigeminal nerve, confirming the suspected etiology of stroke, and demonstrating that prior vascular involvement coincides with the location of trigeminal nerve damage. In some of these patients, oculofacial pain is a distinctive feature.

Abstract: Acute anterior uveitis is the most common form of uveitis and is also a common cause of vision loss in most regions of the world, but the exact etiology cannot be elucidated in some cases. Uveitis is a sight-threatening inflammation inside the eye that affects both the uveal tract and adjacent structures and is the most frequent extra-articular manifestation of ankylosing spondylitis (AS). The prevalence of acute non-granulomatous anterior uveitis (ANGAU) in AS patients has been reported to be as high as 25% to 40% during the course of the rheumatic disease [1,2,3]. In our experience, only 2% of patients are accurately diagnosed by an ophthalmologist at the onset of AS, although 22% of chronic AS patients develop uveitis, thus the availability of correctly characterized biological samples for further analysis is limited. The pathogenesis of AS with ANGAU usually has a strong genetic linkage with human leukocyte antigen (HLA)-B27 [4]. In addition, a genetic association of HLA with human infection by helminthes has been reported [5]. Infection with Toxocara canis is among the most common zoonotic infections worldwide and is a well-recognized cause of uveitis worldwide [6,7]. Humans can be infected with these parasites by ingestion of soil or contaminated meat containing Toxocara eggs. Ocular toxocariasis causes permanent vision loss in many patients and Toxocara is an important causative agent of posterior and diffuse uveitis [7]. However, Toxocara should be considered as a possible causative agent of ANGAU. There is some evidence that the occurrence of helminthes and the prognosis of rheumatic disease are linked [8,9]. In this context, Peng [10] has reported that potential parasitosis must be considered in patients with rheumatic diseases. Williams and Roy [11] have reported a case of arthritis associated with toxocaral infestation. Furthermore, an association of arthritis with infection due to helminthes, such as Strongyloides stercoralis, has been reported [12,13]. A study conducted by Kuk et al. [14] reported Toxocara seropositivity in AS patients. Reports regarding the influence of toxocariasis in patients with AS-associated uveitis are limited and the relationship between toxocariasis and AS-associated uveitis is unclear. Thus, the aim of this work was to determine the presence of antibodies against T. canis in AS patients with ANGAU. To our knowledge, this is the first report showing the relationship between Toxocara and Mexican AS patients with uveitis.