VITREORETINAL COMPLICATIONS AFTER PENETRATING KERATOPLASTY

Park, Yuli,Kim, Min Hee,Won, Jae Yon,Kim, Hyun Seung,Park, Young-Hoon by Ophthalmic Communications Society, Inc. 2016 Retina Vol.36 No.11

<P>Purpose: To evaluate the time, incidence, and visual outcome of vitreoretinal complications after penetrating keratoplasty (PK). Methods: A retrospective chart review of 1,594 eyes that underwent PK was conducted. Preoperative characteristics, visual significance, and postoperative vitreoretinal complications were analyzed. Results: The incidence of vitreoretinal complications after PK was 3.3% (52/1,594). The mean follow-up period was 38.5 +/- 29.8 months. The mean time for vitreoretinal complications to occur was 4.8 months. The most common vitreoretinal complication was vitreous hemorrhage (0.75%), and others included choroidal detachment (0.7%), endophthalmitis (0.6%), and retinal detachment (0.5%). Majority of vitreous hemorrhage, endophthalmitis, and choroidal detachment occurred within 1 month postoperatively, but most cases of cystoid macular edema and epiretinal membrane occurred after 3 months. At follow-up after PK, the mean corrected distance visual acuity was worse among eyes that experienced vitreoretinal complications compared with eyes that did not (P = 0.013). Conclusion: Vitreoretinal complications after PK occurred in a significant percentage, resulting in persistent reduction of corrected distance visual acuity. Given this, it is of particular importance to control intraoperative and postoperative intraocular pressure, infection, and inflammation which will contribute to decrease in the incidence of vitreoretinal complications after PK.</P>

COMBINED INTRAVITREAL BEVACIZUMAB INJECTION AND ZONE I SPARING LASER PHOTOCOAGULATION IN PATIENTS WITH ZONE I RETINOPATHY OF PREMATURITY

Kim, Jaeryung,Kim, Sang Jin,Chang, Yun Sil,Park, Won Soon by Ophthalmic Communications Society, Inc. 2014 Retina Vol.34 No.1

PURPOSE:: To investigate the anatomical outcome of combined intravitreal bevacizumab injection and Zone I sparing laser ablation in patients with Type 1 retinopathy of prematurity in Zone I. METHODS:: The medical records of consecutive 18 eyes of 10 infants, who underwent combined intravitreal bevacizumab (0.25 mg) injection and Zone I sparing laser ablation for the treatment of Type 1 retinopathy of prematurity in Zone I, were retrospectively reviewed. Laser photocoagulation was performed on the avascular retina anterior to the margin of Zone I extending to the ora serrata. Anatomical outcomes including progression to stage 4/5, macular changes, and vitreous organization were reviewed. RESULTS:: The mean gestational age at birth and the birth weight of included patients were 24.0 weeks and 628 g, respectively. The timing of bevacizumab injection ranged from postmenstrual age 33 to 35 weeks (mean, 34.3 weeks). Postmenstrual age at last follow-up ranged from 74 to 107 weeks (mean, 83.6 weeks). All 18 eyes demonstrated prompt regression of neovascular pathology and plus disease without recurrence. Previously avascular Zone I retina was vascularized in all eyes after the treatment. All eyes showed excellent anatomical outcome with intact macula, but one eye showed mild vitreous organization above the vascular/avascular junction. CONCLUSION:: Combined intravitreal bevacizumab injection and Zone I sparing laser ablation for Type 1 retinopathy of prematurity in Zone I seem to be effective treatment options. Possible advantages include lower dose of anti–vascular endothelial growth factor, less recurrence than monotherapy, and preservation of central visual field.

IN VIVO DETECTION OF ACUTE ISCHEMIC DAMAGES IN RETINAL ARTERIAL OCCLUSION WITH OPTICAL COHERENCE TOMOGRAPHY: A “Prominent Middle Limiting Membrane Sign”

Chu, Young Kwang,Hong, Young Taek,Byeon, Suk Ho,Kwon, Oh Woong by Ophthalmic Communications Society, Inc. 2013 Retina Vol.33 No.10

PURPOSE:: To describe characteristic findings of acute retinal ischemic damage in optical coherence tomography. METHODS:: Eighteen cases of acute retinal arterial occlusion with available fundus photography, optical coherence tomography, and/or fluorescein angiography in the early phase (<1 month) with more than 2 months follow-up were reviewed. A site-to-site analysis between optical coherence tomography morphology and correlating fundus images were done on each visit. RESULTS:: Retinal opacities at first presentation were vague to mild opacity in four eyes, moderate (affecting visibility of underlying choroidal vessels) in seven, severe (yellow to whitish) in five, and very severe (chalky white) in two. These changes eventually disappear within 1 month (8 of 9 eyes). Inner retinal hyperreflectivity and a “prominent middle limiting membrane” in optical coherence tomography were consistently noticed up to 1 month showing regional correlation with the retinal opaque areas and was readily identified even in areas with vague or disappeared retinal opacities. Later, inner retinal atrophic changes replace these ischemic optical coherence tomography signs. CONCLUSION:: A prominent middle limiting membrane sign is a useful indicator of acute ischemic retinal damage, especially in cases showing subtle or resolved retinal opacities before the onset of atrophic changes.

CENTRAL SEROUS CHORIORETINOPATHY AFTER RENAL TRANSPLANTATION

Lee, Christopher Seungkyu,Kang, Eui Chun,Lee, Kyu Sung,Byeon, Seok Ho,Koh, Hyoung Jun,Lee, Sung Chul The Ophthalmic Communications Society, Inc. 2011 Retina Vol.31 No.9

PURPOSE:: To describe the demographic and clinical characteristics of central serous chorioretinopathy (CSC) after renal transplantation (RT). METHODS:: A retrospective medical chart review was performed on 451 among 2,980 patients, who underwent RT and visited vitreoretinal clinic at Yonsei Medical Center from 1979 to 2009. Correlation between daily corticosteroid dosage and remission time and factors relating to final visual acuity of <20/40 were studied. RESULTS:: Twenty-eight patients (39 eyes) developed CSC at a median of 63 months after RT (range, 2 months to 20 years), and 18 (64%) patients were men. Accordingly, the prevalence of CSC after RT was estimated to be between 1% and 6%. All patients received a combination of corticosteroid and at least one other immunosuppressant agent at presentation. Reducing the daily corticosteroid dosage by 25% to 50% in CSC with classic pattern resulted in twice as faster remission (2 months) compared with the maintained dosage group (P = 0.025). Central serous chorioretinopathy recurrence (P = 0.002), intrinsic renal disease as cause of RT (P = 0.003), severe CSC variant (P = 0.009), and presenting visual acuity <20/40 (P = 0.009) predicted a final visual acuity <20/40. CONCLUSION:: Central serous chorioretinopathy develops relatively often after RT and varies in presentation and severity. The cause of CSC after RT appears to be multifactorial and closely related to corticosteroid.

CHANGES IN MACULAR THICKNESS AFTER PANRETINAL PHOTOCOAGULATION IN PATIENTS WITH SEVERE DIABETIC RETINOPATHY AND NO MACULAR EDEMA

LEE, SUNG BOK,YUN, YONG JUN,KIM, SANG HYUK,KIM, JUNG YEUL The Ophthalmic Communications Society, Inc. 2010 Retina Vol.30 No.5

PURPOSE:: The purpose of this study was to investigate changes in macular thickness after panretinal photocoagulation (PRP) in patients with severe diabetic retinopathy (DR) without macular edema and to compare the visual acuity outcomes. METHODS:: This prospective cohort study included 30 patients with severe nonproliferative DR or non–high-risk proliferative DR whose visual acuity was ≥0.8 before PRP. Sixty eyes of 30 patients with severe nonproliferative DR or non–high-risk proliferative DR received biweekly PRP treatment in 4 sessions. Macular thickness and visual acuity were measured before and at 1, 3, 6, and 12 months after PRP. RESULTS:: The visual acuities were 0.02 ± 0.11 before PRP and 0.04 ± 0.11, 0.04 ± 0.07, 0.02 ± 0.07, and 0.04 ± 0.08 at 1, 3, 6, and 12 months after PRP, respectively (P > 0.05 for each). Central macular thickness was increased at 1 (223.3 ± 40.6 μm), 3 (216.8 ± 23.5 μm), 6 (219.4 ± 33.1 μm), and 12 months (220.4 ± 17.3 μm) after PRP compared with that before PRP (199.0 ± 20.9 μm; P < 0.05 for each). CONCLUSION:: Biweekly PRP (1,200–1,600 spots) had no effect on visual acuity in patients with severe DR without macular edema, which was determined by clinical and optical coherence tomography examination, although mild macular thickening frequently persists.

RESULTS OF VITRECTOMY FOR BREAKTHROUGH VITREOUS HEMORRHAGE ASSOCIATED WITH AGE-RELATED MACULAR DEGENERATION AND POLYPOIDAL CHOROIDAL VASCULOPATHY

Jung, Jae Ho,Lee, Ja Kyun,Lee, Ji Eun,Oum, Boo Sup The Ophthalmic Communications Society, Inc. 2010 Retina Vol.30 No.6

PURPOSE:: The purpose of this study was to evaluate the results of vitrectomy in patients with vitreous hemorrhage associated with age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). METHODS:: A retrospective review was conducted of consecutive cases of patients undergoing pars plana vitrectomy for nonclearing vitreous hemorrhage associated with neovascular AMD or PCV. RESULTS:: Twenty-four eyes of 23 patients were included. The mean length of time from the onset of vitreous hemorrhage to operation was 4.3 months. Twelve eyes had AMD, and 12 eyes of 11 patients had PCV. Additional treatments for active choroidal neovascular-ization or PCV were required in 12 eyes during follow-up. The mean visual acuity improved significantly from a logarithm of the minimum angle of resolution of 2.79 ± 0.85 before operation to 1.61 ± 0.98 at 2 months after operation (P < 0.001). Visual acuity was ≥20/200 in 9 eyes (37.5%) at 2 months after operation; 1 eye was in the AMD group, and the other eyes were in the PCV group. Improvement was more frequently observed in the PCV group (P = 0.005). CONCLUSION:: In this series, the functional outcomes of vitrectomy for vitreous hemorrhage associated with AMD were inferior to outcomes of the PCV group. Vitrectomy is beneficial for improving visual function in select cases of breakthrough vitreous hemorrhage.

Intraocular Foreign Body Removal by Viscoelastic Capture Using DisCoVisc During 23-Gauge Microincision Vitrectomy Surgery

Park, Joon Ho,Lee, Jun Hun,Shin, Jae Pil,Kim, In Taek,Park, Dong Ho The Ophthalmic Communications Society, Inc. 2013 Retina Vol.33 No.5

Fibrin Glue-Assisted Conjunctival Closure in Pars Plana Vitrectomy Where Conjunctival Closure With a Suture Would Be Difficult

CHOI, SI HWAN,LEE, EUN KYOUNG,NAM, KI YUP,KIM, JUNG YEUL The Ophthalmic Communications Society, Inc. 2010 Retina Vol.30 No.4

ASSOCIATION OF PLASMA MALONDIALDEHYDE WITH ARMS2 GENETIC VARIANTS AND PHENOTYPES IN POLYPOIDAL CHOROIDAL VASCULOPATHY AND AGE-RELATED MACULAR DEGENERATION

Park, Dong Ho,Shin, Jae Pil,Kim, In Taek by Ophthalmic Communications Society, Inc. 2014 Retina Vol.34 No.6

PURPOSE:: To evaluate the relationships between plasma malondialdehyde (MDA) level and ARMS2 variants and phenotypes in patients with polypoidal choroidal vasculopathy (PCV) and neovascular age-related macular degeneration (nAMD). METHODS:: This study is a retrospective case–control study. Plasma MDA was measured in 84 controls, 62 patients with PCV, and 42 patients with nAMD. Participants were genotyped for ARMS2 polymorphism. Phenotypes including bilaterality and greatest linear dimension based on fluorescein angiography (FA-GLD) and indocyanine green angiography (ICGA-GLD), were evaluated. RESULTS:: Plasma MDA in the PCV and nAMD groups was higher than in the control group (P < 0.001, respectively). For ARMS2 variants, plasma MDA of homozygous high-risk genotype (TT) was higher than that of homozygous low-risk genotype (GG) in all groups (P < 0.001, respectively). Plasma MDA was higher in homozygous high-risk genotype than in heterozygous genotype in the control, PCV, and nAMD groups (P = 0.021, 0.002, and 0.004, respectively). In the nAMD group, there was a correlation between plasma MDA and both FA-GLD (r = 0.418, P = 0.006) and ICGA-GLD (r = 0.329, P = 0.033). There was a difference in plasma MDA between patients with unilateral and bilateral lesions in both PCV and nAMD (P = 0.017 and 0.019, respectively). CONCLUSION:: This study revealed significant relationships between the plasma MDA level and ARMS2 variants and phenotypes in PCV and nAMD.

HYPERREFLECTIVE EXTERNAL LIMITING MEMBRANES AFTER SUCCESSFUL MACULAR HOLE SURGERY

Oh, In Kyung,Oh, Jaeryung,Yang, Sun Mo,Ahn, Soh Eun,Kim, Seong-Woo,Huh, Kuhl The Ophthalmic Communications Society, Inc. 2012 Retina Vol.32 No.4

PURPOSE:: To evaluate changes in external limiting membranes (ELMs) in the foveae of patients with surgically closed macular holes. METHODS:: In this retrospective observational case series, spectral-domain optical coherence tomography scan images were obtained from eyes of patients with macular holes closed after vitrectomy. The integrity of the ELMs was evaluated at the fovea. In eyes with a restored ELM, the reflectivity of the ELM was estimated. RESULTS:: At a mean of 19 months (range, 3.0–59.7 months) after surgery, the integrity of the ELM was restored in 21 (77.8%) of 27 eyes with closed macular holes. The ELM was not restored in six eyes with glial sealing, in which glial tissues were present in the entire retinal layer. All 21 eyes with restored ELMs had an area of hyperreflectivity within the ELM observed at the thinnest part of the fovea; this was associated with an underlying photoreceptor defect. CONCLUSION:: Abnormally hyperreflective ELMs were frequently observed at the thinnest point of the fovea after macular hole surgery. These hyperreflective ELMs may be newly formed after surgery.