Han Jo Kwon

Natural History of Idiopathic Epiretinal Membrane in Eyes with Good Vision Assessed by Spectral-Domain Optical Coherence Tomography

Purpose: To investigate the natural history of idiopathic epiretinal membrane (ERM) in eyes with good visual function using optical coherence tomography (OCT). Methods: Sixty-two eyes of 58 patients with idiopathic ERM, visual acuity of 20/40 or better, and no significant metamorphopsia were included. The best corrected visual acuity (BCVA), central macular thickness (CMT), membrane configuration, and ellipsoid zone signal data over 24 months were retrospectively analyzed. Based on OCT findings, ERM configurations were categorized as global attachment (GA), partial attachment (PA), pseudohole, and vitreomacular traction (VMT). Results: The mean BCVA and CMT did not change significantly between baseline and 24 months. GA, PA, pseudohole, and VMT types were observed in 33, 19, 9, and 1 eye at baseline, and in 20, 22, 10, and 1 eye at 24 months, respectively. A membrane configuration change was noted in 24 eyes (38.7%) during follow-up, and the distribution shifted from GA to the other types (p < 0.001). Six eyes had visual loss due to membrane progression, and 4 eyes had spontaneous membrane separation. Of the 10 eyes with progression or separation, 6 were of the PA type. Conclusions: Although the BCVA remains stable over 2 years in most idiopathic ERM eyes with good visual function at baseline, the membrane configuration may change, affecting visual acuity. The GA type would be an early stage, and the PA type is prone to changes in visual acuity.

Microbiological study of therapeutic soft contact lenses used in the treatment of recurrent corneal erosion syndrome.

Objective: To determine the bacteriological spectrum of the removed therapeutic soft contact lenses (TSCLs) and to establish efficacy of prophylactic antibiotics on TSCLs used for 2 weeks for treatment of patients with recurrent corneal erosion syndrome (RCES). Methods: This study included idiopathic RCES treated using highly oxygen-permeable silicone hydrogel contact lenses (CLs), and treated 4 times per day with topical tobramycin 3% for 2 weeks. After TSCLs were applied for 2 weeks, the lenses were removed with sterile forceps under which a speculum was inserted, and placed on blood agar with the inner face down. The TSCLs were analyzed for bacterial colonization, and antibiotic susceptibility tests were performed for the isolates, using disk diffusion. Results: Of the 40 lenses analyzed, 9 (22.5%) yielded positive cultures. Staphylococcus epidermidis was the most commonly isolated microorganism; there were five methicillin-sensitive coagulase-negative staphylococci and two methicillin-resistant coagulase-negative staphylococci. Furthermore, we found two lenses that were colonized by Enterobacter gergoviae and Citrobacter freundii. All cultured bacteria showed intermediate or complete sensitivity to ciprofloxacin, tigecycline, and tobramycin. Despite bacterial colonization in 9 CLs, no clinical signs of infectious keratitis were found in any of the patients with prophylactic topical tobramycin 3%. Conclusions: In case of using TSCLs for 2 weeks, tobramycin or ciprofloxacin may be useful as prophylactic topical antibiotics for preventing secondary corneal infections. Considering currently growing incidence of ciprofloxacin-resistant ocular isolates, tobramycin seems to be a reasonable prophylactic topical antibiotic susceptible broad spectrum of bacteria in clinics.

Reduced-Fluence Photodynamic Therapy in Polypoidal Choroidal Vasculopathy Nonresponsive to Ranibizumab

BACKGROUND AND OBJECTIVE To evaluate the effect of reduced-fluence photodynamic therapy (PDT) on polypoidal choroidal vasculopathy (PCV) unresponsive to intravitreal ranibizumab. PATIENTS AND METHODS Patients with PCV unresponsive to ranibizumab administered 3 months consecutively who then received reduced-fluence PDT were retrospectively surveyed. Nonresponders were defined as patients having no reduction in intraretinal and/or subretinal fluid after 3 consecutive treatments. RESULTS In total, 22 of 104 eyes (21.2%) were non-responders, and 16 of 22 nonresponders received reduced-fluence PDT. Nine eyes achieved complete fluid resolution, and six had reduced but persistent fluid. In one eye, fluid persisted at 6 months despite an additional anti-vascular endothelial growth factor (anti-VEGF) injection after reduced-fluence PDT. Mean macular thickness decreased significantly at 3 and 6 months after PDT, but the mean visual acuity was worse than baseline. CONCLUSION Reduced-fluence PDT in nonresponders gradually decreased intraretinal and/or subretinal fluid over several months but did not maintain visual acuity.

ASSOCIATION BETWEEN TANGENTIAL CONTRACTION AND EARLY VISION LOSS IN IDIOPATHIC EPIRETINAL MEMBRANE.

Purpose: To investigate the clinical features associated with early visual loss in patients with idiopathic epiretinal membrane. Methods: Patients with idiopathic epiretinal membrane with visual acuity of ≥20/40, intact ellipsoid zone, and follow-up duration of at least 24 months were included in this retrospective age-matched control study. The disk–fovea–vascular (DFV) distance, central macular thickness, membrane configuration, and ellipsoid zone were assessed using fundus photography and spectral domain optical coherence tomography. Results: We analyzed the progression group (n = 15; vision loss ≥2 lines because of membrane progression) and the control group (n = 30; age matched). Compared with the controls, the mean DFV distance decreased (P < 0.001), central macular thickness increased (P = 0.017), and the ratio of the follow-up and baseline DFV distances (traction index of membrane) was significantly lower (P = 0.001) in the progression group. No differences were observed in the follow-up membrane configuration and ellipsoid zone. Factors associated with early vision loss were the DFV distance change (&rgr; = 0.657; P = 0.008) and traction index of membrane (&rgr; = −0.636; P = 0.011). Their area under receiver-operating characteristic curves were significant (DFV distant change: 0.915, traction index of membrane: 0.910, respectively; P < 0.001, both). Conclusion: Assessing the DFV distance is useful in quantifying the tangential contraction of macula and the prediction of vision loss in idiopathic epiretinal membrane.

Changes in Visual Acuity after Idiopathic Epiretinal Membrane Removal: Good versus Poor Preoperative Visual Acuity.

Purpose: To investigate postoperative visual acuity changes following idiopathic epiretinal membrane (ERM) surgery as well as investigate the relationship between outcome and baseline visual acuity. Methods: The medical records of 159 consecutive eyes were retrospectively reviewed for best corrected visual acuity (BCVA), central subfield macular thickness (CSMT), and the ellipsoid zone (EZ) signal of the photoreceptor layer at baseline and 1, 3, and 6 months after surgery. Patients were divided into two groups: group A, with good vision of 20/50 or better, and group B, with poor visual acuity worse than 20/50. Results: Seventy-nine eyes were included in group A and 80 eyes in group B. Mean baseline BCVA was 0.28 and 0.65 logarithm of the minimum angle of resolution (logMAR), and the mean baseline CSMT was 423.7 and 505.6 μm in group A and group B, respectively. In group A, BCVA worsened to 0.39 logMAR at 1 month (p < 0.001) and gradually improved to 0.25 logMAR at 6 months, which was not different from baseline BCVA. In group B, BCVA and CSMT improved at 1, 3, and 6 months (p < 0.05). The EZ signal improved in group B (p = 0.003) but not in group A. The area under the receiver operating characteristic curve for the improvement in BCVA of ≥2 lines was significant for preoperative BCVA (0.717, 95% confidence interval 0.638-0.797; p < 0.001). The cutoff value was 0.35 on the logMAR scale. Conclusion: After ERM surgery, patients with good vision maintained visual acuity after temporary worsening of vision, and patients with poor vision achieved significant BCVA improvement.

Impact of Age on Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

Purpose The purpose of this study is to investigate new prognostic factors in associated with primary anatomical failure after scleral buckling (SB) for uncomplicated rhegmatogenous retinal detachment (RRD). Methods The medical records of patients with uncomplicated RRD treated with SB were retrospectively reviewed. Eyes with known prognostic factors for RRD, such as fovea-on, proliferative vitreoretinopathy, pseudophakia, aphakia, multiple breaks, or media opacity, were excluded. Analysis was performed to find correlations between anatomical success and various parameters, including age. Results This study analyzed 127 eyes. Binary logistic regression analysis revealed that older age (≥35) was the sole independent prognostic factor (odds ratio, 3.5; p = 0.022). Older age was correlated with worse preoperative visual acuity (p < 0.001), shorter symptom duration (p < 0.001), presence of a large tear (p < 0.001), subretinal fluid drainage (p < 0.001), postoperative macular complications (p = 0.048), and greater visual improvement (p = 0.003). Conclusions Older age (≥35) was an independent prognostic factor for primary anatomical failure in SB for uncomplicated RRD. The distinguished features of RRD between older and younger patients suggest that vitreous liquefaction and posterior vitreous detachment are important features associated with variation in surgical outcomes.

Microstructural changes in the fovea following autologous internal limiting membrane transplantation surgery for large macular holes

decompensated monofixation syndrome (type IV);one (1.9%)hadaccommodative convergence excess without far-distance deviation; three (5.7%) had intracranial diseases (ICD; typeV).Nocyclic (typeVI) or secondary (type VII) AACE was found. In accordance with previous studies (Cho et al. 2009; Buch&Vinding 2015), the most common type was accommodative AACE (type III): nine children [32.1%, mean age 3.6 1.1 years (2–5)] had pure refractive accommodative AACE, ten [35.7%, 2.4 0.1 years (1–4)] had partially refractive accommodative AACE, and nine [32.1%, 3.6 1.8 years (1–6)] had accommodative decompensated monofixation syndrome. The deviation was significantly greater for near distance [nd, mean 41.6 prism dioptres (pd) 16.6 (10–70)] than for fd [mean 31.4 pd 16.4 (4– 60), p = 0.02]. The second most common type was idiopathic AACE (type II). Fourteen children (70%) showed an early onset [mean 2.4 0.6 years (1–3)] and six (30%) a late onset [mean 4.5 0.8 years (4–6)]. The deviation was greater for nd [mean 42.6 pd 10.6 (20–64)] than for fd [mean 37.2 pd 9.2 (24–40)], with nd > fd in 13 (65%) and nd = fd in 7 (35%) cases. The degree of hyperopia was less than for children with accommodativeAACE (1.68 1.2 dioptres in spherical equivalent [D(se), 0–3.5) versus 2.75 1.4 D (se, 1–5.5), p = 0.01]. Precipitating stressors were reported in four cases (13.8%), including three febrile infections and psychological stress at the hairdresser. Three cases (5.7%) were associated with ICD (type V). The first was a 3year-old boy with a sinus vein thrombosis. He presented with nystagmus, bilateral papilloedema, a deviation nd > fd [40 pd and 30 pd, hyperopia of 1 D(se)] and absent family history. Case two was a 2-year-old boy with congenital mega cisterna magna and s/ p hydrocephalus, 3.5 D(se) hyperopia, positive family history and a deviation of 40 pd (fd = nd). Case three was a 2year-old girl with viral meningitis and 5.5 D(se) hyperopia causing accommodative strabismus when the infection started [negative family history, deviation of 30 pd (nd) and 40 pd (fd)]. In conclusion, our findings affirm the value of most risk factors (RFs) for ICD described by Buch & Vinding (2015) and confirm accommodative strabismus to be the typical cause of AACE. The diagnosis of AACE led to the detection of an ICD in one of our cases. This child would have been identified by the screening fromBuch et Vinding, showing the RFs nystagmus and papilloedema. Two further children were referred from a children’s hospital with already known ICDs, other neurological pathologies and AACE. Similar to Buch & Vinding (2015); low hyperopia was not a significant RF, and also no children were myopic. A majority of our children [32 of 50 (64%)] without ICDs had hyperopia <3 D(se). From our point of view, accommodative AACE can be diagnosed without magnetic resonance imaging (MRI) in most cases. Therefore, the crucial point of interest is to separate idiopathic from neurological AACE. Our data and other literature (Sturm et al. 2012) reveal a small degree of hyperopia in idiopathic AACE. Hence, we would recommend that the value of hyperopia as a RF should not be overestimated. The limitation of our study is the small number of ICDs. Because neurological AACE (type V) is so rare, more data concerning this issue are needed. We consider the elaboration of RFs to be important for deciding how invasive diagnostic testing should be.

Exclusive Use of Air as Gas Tamponade in Rhegmatogenous Retinal Detachment

Purpose To investigate outcomes of vitrectomy for rhegmatogenous retinal detachment (RRD) using air exclusively as the gas tamponade. Methods This retrospective, interventional, consecutive case series involved reviewing medical records of patients that underwent vitrectomy and gas tamponade for RRD between January 2013 and December 2015. Patients whose eyes were treated exclusively with air tamponade since July 2014 were assigned to the air group, while those treated with heterogeneous gas agents before June 2014 were assigned to the control group. The primary outcome was the primary reattachment rate. Best-corrected visual acuity (BCVA) and duration to detect redetachments were assigned as the secondary outcomes. Results The air group and the control group included 71 and 72 eyes, respectively. The primary reattachment rate was 94.4% in the air group and there was no significant difference with 94.4% in the control group (p = 0.951). BCVA was significantly better in the air group at 1 month (p = 0.021) but not at 3 months postoperatively (p = 0.561). Redetachments were recognized earlier in the air group (9.3 ± 0.5 days) compared with those in the control group (21.3 ± 7.4 days) (p = 0.041). Conclusions In cases of simple RRD with sufficient removal of subretinal fluid, air could be considered for use as gas tamponade. This trial is registered with KCT0002358.

Diagnostic Value of Positive Findings of Toxoplasma gondii-Specific Immunoglobulin M Serum Antibody in Uveitis Patients to Confirm Ocular Toxoplasmosis

ABSTRACT Purpose: To assess the value of positive immunoglobulin (Ig) M serum antibody (Ab) findings in uveitis patients. Methods: We reviewed medical records of patients who had a positive serological test for Toxoplasma gondii-specific IgM Ab. Their clinical data, including history, demographic characteristics, laboratory findings, clinical findings, treatment outcomes, and recurrences, were reviewed retrospectively. Results: Of 2919 uveitis patients who underwent a serological test for suspected ocular toxoplasmosis (OT), 18 presented with positive Ig M results. All 18 patients (100.0% specificity) were clinically diagnosed with OT. None had any retinochoroidal scar at the initial visit, indicating the OT was a recent and primary infection. However, 15 patients (83.3%) had no history suspected to account for the Toxoplasma transmission. Conclusions: The T. gondii IgM serum Ab is a specific biomarker for diagnosis of primary OT. Epidemiological studies are warranted to investigate the non-classic transmission routes of T. gondii in OT.

Gender Differences in the Relationship between Sex Hormone Deficiency and Soft Drusen

ABSTRACT Purpose: To investigate the association between sex hormone deficiency and soft drusen in women and men. Materials and Methods: We retrospectively reviewed the medical records and fundus photographs of subjects who underwent a health screening for additional examination of climacterium and age-related changes including sex hormone status. In women, sex hormone deficiency was defined as cessation of menstruation that had lasted for at least 12 months and follicular stimulating hormone (FSH) levels ≥ 25 mIU/mL; in men, it was defined as testosterone levels ≤ 3.5 ng/mL. The subjects were divided into two groups—the soft drusen and control groups—based on the presence of soft drusen in the fundus photographs. The total drusen area was measured using ImageJ™ software. Results: Of total 2036 subjects, 638 (271 women; 367 men) were included. Two hundred thirteen subjects (33.4%) had soft drusen (97/271 women, 116/367 men). In women, sex hormone deficiency was more common in the soft drusen group than in the control group (P < 0.001); this was not the case in men. Multivariate logistic regression analysis revealed that sex hormone deficiency was an independent risk factor for soft drusen in women (P < 0.001; odds ratio [OR] = 3.494), as was age (P < 0.001; OR = 1.092). A long post-menopausal period was a risk factor for large soft drusen (≥ 125 μm). (P < 0.001; OR = 1.220). Age was significantly associated with total drusen area in both women (P = 0.022; β = 0.406) and men (P = 0.015; β = 0.246). Conclusions: Sex hormone deficiency and its duration were significantly associated with the development and progression of soft drusen in women but not in men. It may be necessary to assess and manage the sex hormone deficiency in women with age-related macular degeneration.