Jae Kyoun Ahn

Correlation between a disc hemorrhage and peripapillary atrophy in glaucoma patients with a unilateral disc hemorrhage.

PurposeTo investigate the correlation between a disc hemorrhage and peripapillary atrophy in glaucoma patients with a unilateral disc hemorrhage. MethodsThe 44 glaucoma patients (7 with primary open-angle glaucoma and 37 with normal-tension glaucoma) with a unilateral disc hemorrhage from June 1997 to November 2002 were selected randomly and included sequentially. The topographic measurements were performed using Heidelberg Retina Tomograph (HRT) within 3 months of detecting the disc hemorrhage. The zone beta parameters of the peripapillary atrophy were analyzed by the Atrophy Zone Analysis software. The intraocular pressure, refractive error, visual field parameters, and optic disc parameters were compared between both eyes. Univariate and multivariate regression analysis were performed. ResultsThe area, angular and radial extent of the zone beta, and the ratio of the zone beta area to the disc area were significantly greater in the hemorrhagic eyes than in the contralateral eyes (P < 0.001). The prevalence of peripapillary atrophy was significantly higher in the hemorrhagic eyes (84%) than in the contralateral eyes (66%) (P = 0.034, &khgr;2 test). The rim area and the rim volume of the hemorrhagic eyes were significantly smaller than those of the contralateral eyes (P = 0.02, < 0.001, respectively). In multivariate regression analysis, the peripapillary atrophy area was the independent significant factor associated with disc hemorrhage (P = 0.03, Odds Ratio = 1.51). The refractive error, intraocular pressure, Mean Deviation (MD), and Corrected Pattern Standard Deviation (CPSD) of the visual fields in both eyes were similar. ConclusionThe area and extent of the peripapillary atrophy was significantly greater and more prevalent in the eyes with a disc hemorrhage than in the contralateral control eyes. Peripapillary atrophy is closely associated with a disc hemorrhage in glaucoma patients irrespective of small neuroretinal rim area and volume.

Changes in Aqueous Vascular Endothelial Growth Factor and Pigment Epithelium-derived Factor after Ranibizumab Alone or Combined with Verteporfin for Exudative Age-related Macular Degeneration

PURPOSE To investigate changes in aqueous vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) in choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) after ranibizumab (Lucentis; Genentech Inc, South San Francisco, California, USA) monotherapy or combined with photodynamic therapy (PDT). DESIGN Prospective, interventional, case-control study. METHODS We recruited 34 patients with CNV secondary to AMD and 10 controls. Baseline examinations, including visual acuity (VA), central macular thickness (CMT), fluorescein angiography, and indocyanine angiography, were performed, and the measurements of VA and CMT were repeated 1 month after treatments. Seventeen of 34 patients received a single intravitreal injection of 0.5 mg ranibizumab, and the remaining 17 patients underwent combined PDT on the same day. Aqueous samples were collected at the time of injection and 1 month after treatment and were measured by enzyme-linked immunosorbent assay. Main outcomes measures were the changes in VA and CMT and the changes in VEGF and PEDF levels. RESULTS Demographic features, lesion characteristics, and mean changes in VA and CMT were similar between the two groups. Aqueous VEGF and PEDF levels were reduced significantly 1 month after treatment in all patients. The reduction levels of VEGF and PEDF were similar between the two groups. There was a positive correlation between the reduction levels of aqueous VEGF and the reduction levels of aqueous PEDF. The reduction levels of VEGF and PEDF were correlated positively with the decrease in CMT, but were not positively correlated with the improvements in VA. CONCLUSIONS Ranibizumab therapy for CNV secondary to AMD is associated with reduced levels of aqueous VEGF and PEDF regardless of combined therapy with PDT. The reduction levels of VEGF and PEDF are correlated with anatomic improvements in the macula.

Intravitreal Triamcinolone Reduces the Morphologic Changes of Ciliary Body After Pars Plana Vitrectomy for Retinal Vascular Diseases

PURPOSE To investigate the early postoperative changes in ciliary body after pars plana vitrectomy (PPV) for retinal vascular disease and to determine whether intravitreal triamcinolone acetonide (IVTA) affects postvitrectomy changes of the ciliary body. DESIGN Prospective interventional case-control study. METHODS We recruited 46 patients who underwent uncomplicated PPV for retinal vascular disease (35 with proliferative diabetic retinopathy (PDR) and 11 with branch retinal vein occlusion) and divided the patients into two groups according to the use of IVTA at the end of the PPV. The morphologic changes of the anterior segments were measured by ultrasound biomicroscopy (UBM) one day before and one day, two days, three days, five days, two weeks, one month, and two months after the PPV. The main outcome measures were the thickness and area of the ciliary body, the frequency of supraciliary effusions (SEs), angle-opening, and anterior chamber depth (ACD). We compared the UBM parameters between the two groups. RESULTS The thickness and area of the ciliary body significantly increased from day 1 to day 5 postoperatively. Nineteen of 46 eyes had SEs that were frequently associated with divergent alterations of postoperative intraocular pressure (IOP). The angle-opening and ACD were significantly decreased and dependent upon the findings of ciliary body thickness and SEs. The degree of the morphologic changes of the ciliary body and the frequency of SEs were significantly lower and of shorter duration in the IVTA group compared to the non-IVTA group. CONCLUSIONS The PPV for retinal vascular disease induces the morphologic changes of the ciliary body associated with postoperative abnormalities in IOP during the early postoperative period. Administration of IVTA at the end of the PPV effectively reduces or shortens the duration of the postvitrectomy changes of the ciliary body.

An Epidemic of Chronic Pseudophakic Endophthalmitis Due to Ochrobactrum anthropi: Clinical Findings and Managements of Nine Consecutive Cases

Purpose: To report an epidemic of O. anthropi pseudophakic endophthalmitis. Methods: The medical records of nine patients with culture-proven O. anthropi endophthalmitis were reviewed. Results: The presenting features were compatible to chronic endophthalmitis. Two patients showed coinfections with P. acnes. Antibiotics sensitivity test revealed susceptibility to quinolones. Pars plana vitrectomy (PPV) with partial capsulectomy (PC) cured infections in seven patients without coinfection of P. acnes. Final visual acuity was 20/40 or better in five patients. Conclusions: O. anthropi should be considered in cases with chronic pseudophakic endophthalmitis. PPV with PC should be the initial therapeutic option for O. anthropi endophthalmitis.

Morphologic changes in the anterior segment after phacovitrectomy for proliferative diabetic retinopathy

PURPOSE: To determine whether combined phacoemulsification and intraocular lens implantation with pars plana vitrectomy (PPV) (phacovitrectomy) in patients with proliferative diabetic retinopathy (PDR) causes morphologic changes in the anterior segment and to evaluate whether there is a relationship between the anatomic changes and inflammatory complications. SETTING: Department of Ophthalmology, Chonnam National University Hospital, Gwangju, South Korea. METHODS: Patients who had uneventful surgery for PDR were divided into 2 groups (phacovitrectomy and PPV only). Morphologic changes in the ciliary regions were measured by ultrasound biomicroscopy (UBM) 1 day before surgery and 1, 2, 3, 5 days, 2 weeks, 1 and 2 months after surgery. The UBM parameters and inflammatory complications in the 2 groups were compared. RESULTS: The study comprised 60 patients; 30 had phacovitrectomy and 30, PPV only. The frequency of supraciliary effusions was higher in the phacovitrectomy group (24/30, 80%) than in the PPV‐only group (14/30, 46%) (P = .015). The decrease in angle opening and anterior chamber depth was more prominent after phacovitrectomy. The incidence of complications was higher in the phacovitrectomy group than in the PPV‐only group (60% versus 30%, abnormal intraocular pressure; 30% versus 7%, intraocular fibrin and posterior synechia formation); the complications were associated with supraciliary effusions. CONCLUSIONS: The results indicate that phacovitrectomy for PDR may induce more morphologic changes in the anterior segment. Supraciliary effusions were associated with inflammatory complications. Appropriate control of postsurgical inflammation is necessary in phacovitrectomy for PDR.

Morphologic changes in the anterior segment in patients with initial-onset or recurrent Vogt-Koyanagi-Harada disease.

Purposes: To investigate morphologic changes in anterior segments based on inflammatory phases of Vogt-Koyanagi-Harada (VKH). Methods: The author recruited 76 consecutive eyes of 38 patients with initial-onset VKH and 52 eyes of 26 patients with recurrent VKH. Morphologic changes in anterior segments were measured by ultrasound biomicroscopy (UBM). UBM parameters and intraocular pressure (IOP) were compared between two groups. Results: Ciliary thickness and area significantly increased in the recurrent group compared with the initial-onset group. Twelve patients (31%) in the initial-onset group showed supraciliary effusions, but no patients in the recurrent group had supraciliary effusions. Angle opening and anterior chamber depth were significantly decreased in the initial-onset group compared with the recurrent group. High IOP > 30 mmHg was found in 7 patients with initial-onset disease, while low IOP < 10 mmHg was detected in 6 patients with recurrent disease. Conclusions: The results indicate that morphologic changes associated with IOP alterations depend on inflammatory phases of VKH disease.

Effect of 10-mm Superior Oblique Posterior Tenectomy Combined with Frenulum Dissection in A-Pattern with Superior Oblique Overaction

PURPOSE To evaluate the effect of 10-mm tenectomy of the posterior fibers of the superior oblique (SO) tendon combined with dissection of the frenulum for correction of A-pattern deviation and vertical deviation with SO overaction. DESIGN Retrospective, interventional case series. METHODS Seventy-five patients with A-pattern strabismus associated with SO overaction who underwent surgery between March 1, 2004 and August 31, 2007. Retrospective analysis of A-pattern strabismus patients with SO overaction who underwent unilateral or bilateral 10-mm SO posterior tenectomy combined with frenulum dissection and who underwent at least 12 months of follow-up. RESULTS The mean preoperative amount of A-pattern for all patients was 21.20 +/- 7.25 prism diopters (PD), with a mean postoperative collapse of 17.63 +/- 5.33 PD (range, 10 to 30 PD), which was statistically significant (P = .001). After surgery, the mean A-pattern correction was 22.12 +/- 6.30 PD in the group that underwent bilateral posterior tenectomy and 13.33 +/- 5.20 PD in the group that underwent unilateral posterior tenectomy. The mean degree of preoperative vertical deviation in the group that underwent unilateral posterior tenectomy was 11.50 +/- 3.96 PD, and the mean correction was 9.21 +/- 4.22 PD (P = .01). There were no surgical complications, except in 5 patients, who manifested mild inferior oblique overaction. CONCLUSIONS We believe that 10-mm SO posterior tenectomy combined with frenulum dissection effectively collapses A-pattern deviation of less than 25 PD with mild to moderate SO overaction and reduces associated vertical deviation of 10 PD.

Spontaneous malignant glaucoma in a longstanding hypotonous eye.

A 38-year-old man with longstanding low intraocular pressure (IOP) in his right aphakic eye presented with severe pain and high IOP (35 mm Hg). On examination, visual acuity was light perception. The central and peripheral portions of the iris were directly opposed to the posterior corneal surface and synechial closure of the pupil margin. B-scan ultrasonography showed posterior vitreous detachment. The patient was treated with topical cycloplegics, a topical beta-blocker, and a systemic hyperosmotic agent. After 1 week, the anterior chamber was deep centrally, with peripheral synechiae between the iris and the cornea. The IOP of the right eye was 4 mm Hg. This case is an unusual spontaneous malignant glaucoma occurring in a longstanding hypotonous eye.