Joo Yeon Lee

Plus disease in retinopathy of prematurity: development of composite images by quantification of expert opinion.

PURPOSEnTo demonstrate a methodology for generating composite wide-angle images of plus disease in retinopathy of prematurity (ROP), using quantitative analysis of expert opinions.nnnMETHODSnThirty-four wide-angle retinal images were independently interpreted by 22 ROP experts as plus or not plus. All images were processed by the computer-based Retinal Image multiScale Analysis (RISA) system to calculate two parameters: arterial integrated curvature (AIC) and venous diameter (VD). Using a reference standard defined by expert consensus, sensitivity and specificity curves were calculated by varying the diagnostic cutoffs for AIC and VD. From these curves, individual vessels from multiple images were identified with particular diagnostic cutoffs, and were combined into composite wide-angle images using graphics-editing software.nnnRESULTSnThe values associated with 75% underdiagnosis of true plus disease (i.e., 25% sensitivity cutoff) were AIC 0.061 and VD 4.272, the values associated with 50% underdiagnosis of true plus disease (i.e., a 50% sensitivity cutoff) were AIC 0.049 and VD 4.088, and the values associated with 25% underdiagnosis of true plus disease (i.e., 75% sensitivity cutoff) were AIC 0.042 and VD 3.795. Composite wide-angle images were generated by identifying and combining individual vessels with these characteristics.nnnCONCLUSIONSnComputer-based image analysis permits quantification of retinal vascular features, and a spectrum of abnormalities is seen in ROP. Selection of appropriate vessels from multiple images can produce composite plus disease images corresponding to expert opinions. This method may be useful for educational purposes, and for development of future disease definitions based on objective, quantitative principles.

Risk factors predicting the need for additional surgery in consecutive esotropia.

PURPOSEnTo evaluate the risk factors predicting surgical treatment in consecutive esotropia occurring after surgery for intermittent exotropia.nnnMETHODSnThe clinical records of 52 patients with consecutive esotropia who underwent exotropia surgery were retrospectively reviewed. All patients demonstrated consecutive esotropia with diplopia or suppression for more than 1 month after surgery for exotropia. Patients were divided into two groups (the surgical group and nonsurgical group) depending on whether surgery was required for consecutive esotropia. Surgery for esotropia was performed only in patients with more than 10 prism diopters (PD) esodeviation that persisted for a minimum of 6 months, those who had suppression in 1 eye or diplopia, and those who could not achieve fine stereopsis. The nonsurgical treatment up to 6 months postoperatively was part-time patching and prism therapy in both groups. Patient characteristics were evaluated in the two groups.nnnRESULTSnThe surgical group was composed of 17 patients and the nonsurgical group was composed of 35 patients. Age, gender, refractive error, best-corrected visual acuity, and postoperative overcorrection at 1 day were not significantly different in the two groups (P > .05). However, the distance strabismic angle at 1 month postoperatively was 2.5 ± 3.8 PD esodeviation (range: 14 PD esotropia to 4 PD exotropia) in the nonsurgical group and 5.4 ± 5.1 PD esodeviation (range: 20 PD esotropia to orthotropia) in the surgical group; these values were statistically significant (P < .05).nnnCONCLUSIONSnThe clinically significant risk factor affecting the surgical decision for consecutive esotropia was a large esotropic angle at 1 month postoperatively in this study.

Comparison of natural course, intravitreal triamcinolone, and intravitreal bevacizumab for treatment of macular edema secondary to branch retinal vein occlusion.

PURPOSEnTo evaluate the natural course of the eyes with macular edema secondary to branch retinal vein occlusion (BRVO) and to compare the visual outcome and macular thickness with eyes treated with intravitreal injection of triamcinolone acetonide (IVTA) and intravitreal injection of bevacizumab (IVB).nnnMETHODSnWe reviewed the medical records of the patients with macular edema secondary to BRVO who were followed over 12 months. We evaluated the best corrected visual acuity (BCVA) and central macular thickness (CMT) of the patients who have had no treatment for macular edema (natural course group) and compared the BCVA and CMT of the patients who had been treated with IVTA or IVB.nnnRESULTSnBCVA and CMT of the natural course group improved in a slow, but steady manner. The IVTA and the IVB group showed temporary improvement after injection, but macular edema recurred and there was no significant difference in the visual outcome and macular thickness after 6 months.nnnCONCLUSIONSnAlthough IVTA and IVB were effective to decrease the macular edema at 1 month after the injection in BRVO. BCVA and CMT of the natural course group were not inferior to both the IVTA and the IVB groups at 12 months.

Contemplation of the surgical normogram of lateral rectus recession for exotropia associated with superior oblique palsy.

Purpose To suggest a surgical normogram for lateral rectus recession in exotropia associated with unilateral or bilateral superior oblique muscle palsy (SOP). Methods We retrospectively reviewed the charts of 71 patients with exotropia who were successfully corrected over one year. Each patient had undergone unilateral or bilateral rectus recession associated with uni- or bilateral inferior oblique (IO) 14 mm recession, using a modified surgical normogram for lateral rectus (LR) recession, which resulted in 1 to 2 mm of reduction of LR recession. We divided all patients into 2 groups, the 34 patients who had undergone LR recession with unilateral IO (UIO) recession group and the remaining 37 patients who had undergone LR recession with bilateral IO (BIO) recession group. Lateral incomitancy was defined when the exoangle was reduced by more than 20% compared to the primary gaze angle. The surgical effects (prism diopters [PD]/mm) of LR recession were compared between the two groups using the previous surgical normogram as a reference (Parks normogram). Results The mean preoperative exodeviation was 20.4 PD in the UIO group and 26.4 PD in the BIO group. The recession amount of the lateral rectus muscle ranged from 4 to 8.5 mm in the UIO group and 5 to 9 mm in the BIO group. Lateral incomitancy was noted as 36.4% and 70.3% in both groups, respectively (p = 0.02). The effect of LR recession was 3.23 ± 0.84 PD/mm in the UIO group and 2.98 ± 0.62 PD/mm in the BIO group and there was no statistically significant difference between two the groups (p = 0.15). Conclusions Reduction of the LR recession by about 1 to 2 mm was successful and safe to prevent overcorrection when using on IO weakening procedure, irrespective of the laterality of SOP.

Pure Horizontal Strabismus in Inferior Oblique Inclusion Syndrome

Inferior oblique inclusion is a rare complication following lateral rectus surgery. It is caused by inadvertent incorporation of the inferior oblique muscle into the lateral rectus muscle during surgery. The authors demonstrate two cases of inferior oblique inclusion with different manifestations and suggest the detection and proper management of this rare complication.

Long-term Intraocular Pressure Elevation after Primary Angle Closure Treated with Early Phacoemulsification

Purpose To assess long-term changes in intraocular pressure (IOP) and the development of glaucoma after early phacoemulsification in acute primary angle closure. Methods Retrospective chart review of acute primary angle closure patients treated with phacoemulsification in attack eyes versus fellow eyes. Within a month after the angle closure attack, all subjects underwent cataract surgery and were divided into two groups: group A received cataract surgery on their attack eyes. Group B also received cataract surgery on their fellow eye after phacoemulsification of the attack eyes. Study outcomes were the prevalence of IOP rise (occurrence of IOP >21 mmHg) and the incidence of newly developed glaucoma. Results Eighty-nine eyes were included, with 62 attack eyes in group A and 27 fellow eyes in group B. Group A (14 eyes, 22.58%) had a higher cumulative rate of IOP rise than group B (3 eyes, 11.11%) at 12 months (p = 0.001). Newly developed glaucoma was not observed in group B; however, 6 patients in group A developed glaucoma during the 12-month follow-up period (p < 0.001). Conclusions The attack eyes treated with phacoemulsification showed a significantly higher prevalence of IOP rise and newly developed glaucoma than fellow eyes that received phacoemulsification. These findings suggest that there is a possibility of IOP rise and development of glaucoma even when angle closure and successful IOP control have apparently been achieved after phacoemulsification.