Hae Jung Sun

Sudden unilateral visual loss after autologous fat injection into the nasolabial fold

A 27-year-old female presented with sudden visual loss of her right eye after receiving an autologous fat injection into the right nasolabial fold. Fundus examination of the right eye showed multiple whitish patchy lesions with macular edema. Fluorescein angiogram showed deterioration of choroidal circulation with patchy choroidal filling and arm-to-retina circulation time and retinal arteriovenous passage time were delayed to 30 seconds and 20 seconds, respectively. There was no response in flash visual evoked potential (VEP). High dose steroid therapy (methylprednisolone 1 g/day/i.v.) was done and about 2 weeks later, the disc edema subsided and retinal arteriovenous passage time of fluorescein angiogram was normalized but there was no improvement in visual acuity. Absence of a cherry red spot, deterioration of choroidal circulation with patchy choroidal fillings seen in fluorescein angiogram, and no response in flash VEP suggests multiple choroidal infarction due to perfusion defect of the short posterior ciliary artery. The autologous fat injected is thought to have entered the dorsal nasal artery and the retrograde migration of the emboli to the ophthalmic artery might have caused the multiple occlusions of the short posterior ciliary artery.

Surface calcification of hydrophilic acrylic intraocular lens related to inflammatory membrane formation after combined vitrectomy and cataract surgery

UNLABELLED Two patients complained of blurred vision approximately 6 months after having combined vitrectomy and phacoemulsification with implantation of a C-flex 570C hydrophilic acrylic intraocular lens (IOL). Multiple granules were noted on the anterior surface of the IOLs in both patients. Intraocular lens exchange was performed in both eyes, and the explanted IOLs were sent for histopathological analysis. Scanning electron microscopy confirmed the presence of cracks and granules on the IOL surfaces and energy-dispersive x-ray spectroscopy demonstrated calcium deposition. Based on the calcification pattern on the anterior surface of the IOLs, 2 additional cases of opacification were identified under slitlamp examination. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.

Improving intraocular lens power prediction in combined phacoemulsification and vitrectomy in eyes with macular oedema

Purpose:  To report the accuracy of intraocular lens (IOL) power estimation in eyes that have undergone phacovitrectomy for retinal diseases with accompanying macular oedema.

Intraocular lens exchange with removal of the optic only

PURPOSE: To evaluate the clinical outcomes of intraocular lens (IOL) exchange in patients with an opacified ACRL‐C160 intraocular lens (IOL) using an optic‐only removal technique. SETTING: Department of Ophthalmology, Soonchunhyang University Hospital, Seoul, Korea. METHODS: The study comprised eyes with previous phacoemulsification and implantation of a single‐piece hydrophilic acrylic IOL in the capsular bag and subsequent development of severe late opacification of the IOL. In all eyes, the IOL optic was explanted; any haptic with firm adhesions was left in the capsular bag. This was followed by placement of a new IOL. The perioperative complications were evaluated, and the best corrected visual acuity (BCVA) before surgery and after surgery was compared. RESULTS: Twenty‐three eyes of 20 patients were evaluated. Uneventful IOL exchange and placement of a new IOL in the bag was achieved in 9 eyes (39.1%) and in the sulcus in 13 eyes (56.5%), with posterior capsule rupture in 2 eyes (8.7%). One eye (4.3%) developed zonular dehiscence, and scleral IOL fixation was performed. The mean BCVA was 0.64 ± 0.35 logMAR before IOL exchange and 0.24 ± 0.20 logMAR after IOL exchange. During 41 months of follow‐up, 1 eye (4.3%) each was affected by recurrent anterior uveitis and delayed zonular dehiscence. The final mean BCVA was 0.38 ± 0.40 logMAR. There was no corneal decompensation or infectious keratitis. CONCLUSION: The optic‐only removal technique was a safe and helpful procedure that allowed recovery of visual acuity because it decreased the intraoperative complication of zonular dehiscence.

Transscleral Fixation by Injector Implantation of a Foldable Intraocular Lens

Scleral fixation of a foldable intraocular lens (IOL) was performed in 17 eyes of 17 patients using a new small incision technique with injector implantation. All eyes were implanted with a hydrophobic acrylic three-piece IOL, either with phacoemulsification surgery or secondarily. No cases of intraoperative or postoperative complications were observed. The operation time required for scleral fixation only was less than 30 minutes in all cases. Scleral fixation of foldable IOLs using a self-sealing tunnel incision and injector technique minimizes intraoperative hypotony and related complications such as suprachoroidal hemorrhage. Furthermore, this technique saves surgery time and the sutureless technique used for most patients can reduce postoperative astigmatism.

Bariatric surgery is associated with less progression of diabetic retinopathy: A systematic review and meta-analysis ☆

BACKGROUND The impact of bariatric surgery on diabetic retinopathy (DR) remains underexplored, and conflicting results have been reported. OBJECTIVE To clarify the impact of bariatric surgery on DR. SETTING A systematic review and meta-analysis. University Hospital, Korea. METHODS A comprehensive database search was performed across PubMed, Embase, Web of Science, and the Cochrane Library from inception to August 2016. Eligible studies included retrospective or prospective studies reporting changes in DR severity as primary or secondary outcomes after bariatric surgery. A random-effects model was used to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs) for progression of DR. RESULTS Twelve studies composed of 876 patients who underwent bariatric surgery were selected for this systematic review. The pooled ORs showed less DR progression in patients with bariatric surgery than in those with medical treatment alone (OR, .47; 95% CI, .22-.99). The postoperative progression odds were not significantly different between patients with and without DR at baseline (OR, 1.04; 95% CI, .35-3.11). Another meta-analysis investigating the effects of surgery depending on pre-existing sight-threatening DR showed no significant difference (OR, 1.88; 95% CI, .29-12.25) with borderline heterogeneity (I2 = 48%). Remission of diabetes could not prevent the development or progression of DR after surgery. CONCLUSIONS Bariatric surgery has beneficial effects on DR progression compared with medical treatment alone, but there is currently insufficient evidence to assess the effects on DR regression. The progression odds were not significantly different between patients with and without DR preoperatively.

FACTORS ASSOCIATED WITH VISUAL OUTCOME AFTER MACULA-OFF RHEGMATOGENOUS RETINAL DETACHMENT SURGERY.

Purpose: To evaluate preoperative factors influencing the visual outcome and postoperative factors associated with the changes in visual acuity, after reattachment surgery to treat macula-off rhegmatogenous retinal detachment. Methods: A total of 180 eyes of 180 patients who underwent reattachment surgery to treat macula-off rhegmatogenous retinal detachment, and who were followed up for more than 12 months, were reviewed retrospectively. Preoperative and postoperative characteristics, including optical coherence tomography findings, were comprehensively analyzed using univariate and multivariate models to evaluate preoperative factors influencing best-corrected visual acuity 12 months after macula-off rhegmatogenous retinal detachment surgery and postoperative factors associated with changes in best-corrected visual acuity after surgery. Results: Preoperatively, the extent of detachment (P = 0.037), macula-off duration (P < 0.001), and integrity of the external limiting membrane (&bgr; = 0.163; P = 0.002) were significantly associated with postoperative visual prognosis. Six factors were associated with changes in visual acuity after surgery: disruption of ellipsoid zone integrity (&bgr; = 0.167; P < 0.001), the Henles fiber layer and the outer nuclear layer (HFL + ONL)/photoreceptor layer ratio (&bgr; = 0.199; P < 0.001), the photoreceptor outer segment length (&bgr; = −0.020; P < 0.001), the photoreceptor inner segment length/photoreceptor outer segment length ratio (&bgr; = 0.047; P = 0.005), the ratio of photoreceptor layer thickness between the RD eye and fellow eye (&bgr; = −0.126; P = 0.018), and the photoreceptor outer segment length ratio between the RD eye and fellow eye (&bgr; = −0.425; P < 0.001). Conclusion: Preoperative factors associated with the visual outcome after macula-off rhegmatogenous retinal detachment surgery were the extent of detachment, macula-off duration, and external limiting membrane integrity. Postoperatively, predictive factors were the outer retinal microstructures, particularly the photoreceptor outer segment layer.