Ching-Kuang Chou

Relationship Between Central Corneal Thickness, Refractive Error, Corneal Curvature, Anterior Chamber Depth and Axial Length

Background: To determine the relationship between central corneal thickness (CCT), refractive error, corneal curvature, anterior chamber depth and axial length in normal Taiwanese Chinese adults. Methods: Five hundred normal Taiwanese Chinese patients aged 40–80 years were recruited for the study. Measurement procedures included CCT, refractive error, corneal curvature, anterior chamber depth and axial length. Exclusion criteria were previous ocular surgery, glaucoma, trauma history, external eye disease, and previous contact lens use. The relationships among parameters were tested using Pearsons correlation and linear regression analysis. Results: The median CCT was 555 ± 27 μm for males and 553 ± 30 μm for females. Eyes with more myopic refractive error tended to have greater axial length (r =‐0.645, p < 0.001). Eyes with axial elongation tended to have flatter cornea (r =‐0.502, p < 0.001) and deeper anterior chamber (r = 0.651, p < 0.001). There were no significant correlations between the CCT and refractive error (r =‐0.034, p = 0.445), corneal curvature (r = 0.013, p = 0.770), anterior chamber depth (r = 0.023, p = 0.614) and axial length (r =‐0.053, p = 0.223). Conclusion: CCT was not associated with refractive error, corneal curvature, anterior chamber depth and axial length. CCT is an independent factor unrelated to other ocular parameters.

Comparison of the Effects of Latanoprost and Bimatoprost on Intraocular Pressure in Chronic Angle-Closure Glaucoma

PURPOSE The aim of this study was to compare the intraocular pressure (IOP)-lowering effect of latanoprost and bimatoprost as primary therapy in patients with chronic angle-closure glaucoma (CACG) after peripheral iridotomy. METHODS Eighty-two (82) consecutive CACG patients with an IOP greater than 19 mmHg after a peripheral iridotomy were recruited. CACG was defined as chronic elevated IOP, glaucomatous optic neuropathy, and a corresponding visual field defect in eyes with occludable angle and peripheral anterior synechiae on gonioscopy. Patients were randomly assigned to two groups based on daily treatment with either latanoprost 0.005% or bimatoprost 0.03% in the evening for 12 weeks. The IOP was measured at 9 AM and 4 PM on the same day at baseline and also at 4, 8, and 12 weeks. Between-group differences in mean diurnal IOP and IOP reduction were analyzed. RESULTS After 12 weeks of treatment, mean IOP for both the latanoprost and bimatoprost groups was significantly reduced when compared to the baseline value (21.6 +/- 1.9 to 16.4 +/- 2.5 mmHg and 22.1 +/- 2.0 to 16.9 +/- 2.4 mmHg, respectively; P < 0.001 for both). There was no significant difference in IOP reduction between the two treatment groups (P = 0.40). At 4 and 8 weeks, the IOP changes from baseline were statistically significant at both times for both drugs (all P < 0.001). CONCLUSIONS Both latanoprost and bimatoprost significantly reduced IOP in CACG patients who were inadequately treated by laser peripheral iridotomy.

The Long-term Effect of Nd:YAG Laser Iridotomy on Intraocular Pressure in Taiwanese Eyes with Primary Angle-closure Glaucoma

Background: To investigate the long‐term effect of Nd:YAG laser iridotomy on intraocular pressure (IOP) in Taiwaneseeyes with primary angle‐closure glaucoma (PACG). Methods: The medical records of 81 patients (130 eyes) who were diagnosed with PACG and who had undergone Nd:YAG laser iridotomy between 1998 and 2002 were reviewed. According to the presence of symptomatic glaucomaattack, eyes were divided into an acute angle‐closure glaucoma (AACG) group and chronic angle‐closure glaucoma (CACG)group. In the AACG group, the acute episode was treated and resolved after Nd:YAG laser iridotomy. These eyes were diag‐nosed to have or developed glaucoma during the follow‐up period. All patients were followed‐up for at least 24 months. The presenting features, treatment and IOP during the follow‐up period were analyzed. Results: The mean follow‐up period was 44.1 ±17.8 months (median, 36 months). There were 27 eyes (from 25 patients)in the AACG group. Only 2 eyes (7.4%) did not require any treatment after Nd:YAG laser iridotomy. Eleven eyes (40.7%)eventually underwent filtering surgery at a mean of 3.2 months (median, 3 months) after Nd:YAG laser iridotomy. Therewere 103 eyes (from 56 patients) in the CACG group. Eighty‐five eyes (82.5%) required further medical treatment, ofwhich 21 eyes (20.4%) eventually received filtering surgery at a mean of 9.8 months (median, 5 months) after Nd:YAGlaser iridotomy. Conclusion: For most Taiwanese eyes with PACG after Nd:YAG laser iridotomy, additional medicine and surgery arerequired in the long term. Eyes in the AACG group needed more surgical intervention than those in the CACG group.

Early and late endophthalmitis following trabeculectomy in a Chinese population.

Purpose To investigate the rate of bleb-related endophthalmitis over 5 years in a Chinese population. Methods Retrospective chart review. Results Of 988 trabeculectomies performed over 5 years, one case (0.1%) developed early endophthalmitis caused by Morganella morganii, which was rarely reported in the literature. Six cases (0.6%) developed late-onset endophthalmitis. Mitomycin C significantly increased the risk of late-onset endophthalmitis (p=0.0002). Conclusions Physicians should weigh the benefits against the risks of mitomycin C application in performing trabeculectomies.

Cytomegalovirus and herpes simplex virus as causes of bilateral anterior uveitis in an immunocompetent patient.

We report a case with two distinct clinical manifestations of bilateral anterior uveitis caused by two different members of the herpes virus group. A 72-year-old immunocompetent man, who had a documented history of two episodes of Posner-Schlossman syndrome in the left eye, presented with multiple mutton-fat keratic precipitates and elevated intraocular pressure (IOP) in his right eye. Herpes simplex virus Type I DNA was detected by polymerase chain reaction in the aqueous humor of the right eye. One year later, the patient appeared with a few round and whitish keratic precipitates and elevated IOP in his left eye. Polymerase chain reaction analysis showed positive for cytomegalovirus in the aqueous humor of the left eye. During both episodes, the anterior uveitis subsided and IOP returned to normal after systemic and topical antiglaucomatous medication as well as topical steroid.

Refractory Severe Ocular Hypertension after Intravitreal Triamcinolone Acetonide Injection

Purpose: To report a serious complication following intravitreal triamcinolone acetonide injection. Methods: Observational case report. Results: In 2 patients, secondary intractable severe ocular hypertension occurred 2 months after a single 4-mg intravitreal injection of triamcinolone acetonide for macular edema. Both patients required trabeculectomy intervention to control intraocular pressure (IOP). Conclusion: We highlight the occurrence of intractable high IOP elevation as a serious complication 2 months after intravitreal triamcinolone ace- tonide. Cautious monitoring of IOP for several months after this therapy is recommended. The risks of this potentially devastating complication need to be weighed against the benefits of intravitreal triamcinolone in the individual patient.

Endogenous Serratia Marcescens Endophthalmitis-A Case Report

Endogenous bacterial endophthalmitis is uncommon. We reported a 75-year old male presented with concurrent endophthalmitis and orbital cellulitis following Serratia marcescens septicemia after urinary catheterizetion. Culture of the aspirate from the vitreous showed Serratia marcescens, which was also isolated from the blood culture. Third generation Cephalosporin and Amikin were administered according to the sensitivity test. Despite intensive systemic and topical antibiotic therapy, the patient had total vision loss in the affected eye eventually.

Acute Myopia as an Early Manifestation of Vogt-Koyanagi-Harada Disease

Purpose: To report a case of Vogt-Koyanagi-Harada (VKH) Disease who present acute myopia as an initial symptom. Methods: case report. Results: A 31-year-old male suffered from acute myopia in both eyes suddenly and was diagnosed as acute angle-closure glaucoma because of shallow anterior chamber. Miotics treatment took place but his vision did not improve. He was referred to our hospital and normal intra-ocular pressures (ou) were found. He received YAG laser iridectomy in his both eyes and then vision got worse. Fundus examination showed bilateral serous retinal detachments. Fluorescein angiography and cerebral fluid examination confirmed the diagnosis of VKH disease. Intensive steroid treatment started and his vision returned to the normal progressively after one month. Conclusion: Acute-onset myopia and shallow anterior chamber without increased intraocular pressure could be early manifestations of VKH disease