Ju Byung Chae

Endogenous endophthalmitis in the Korean population: a six-year retrospective study.

Purpose: To identify the clinical features, treatment outcomes, and prognostic factors of endogenous endophthalmitis in multiple tertiary referral centers of South Korea over a 6-year period. Methods: The authors conducted a retrospective review of medical records of 57 eyes of 43 patients diagnosed with endogenous endophthalmitis from January 2005 to December 2011, which was referred to tertiary referral centers. Results: Fifty-seven cases of 43 patients were followed for a mean of 18.7 months (range, 0.5–50 months). The common underlying diseases were diabetes mellitus (46.5%) and liver cirrhosis (20.93%). Liver abscess (39.5%) was the most common infection source. Among prognostic factors, the initial visual acuity was associated with favorable visual outcome significantly (P < 0.001). Endogeneous endophthalmitis with gram-negative bacteria had worse visual outcomes than gram-positive bacteria or fungus (P = 0.014). Conclusion: Similar to the findings of previous East Asian studies, this study showed that Klebsiella pneumoniae was the most common causative organism of endogenous endophthalmitis and liver abscess was the most common infection focus. Although endogenous endophthalmitis is generally associated with poor visual acuity outcomes, the prognosis depends mainly on the initial visual acuity and the pathogen.

Effect of combined cataract surgery and ranibizumab injection in postoperative macular edema in nonproliferative diabetic retinopathy.

Purpose: To evaluate whether intravitreal ranibizumab injection at cataract surgery prevents postoperative diabetic macular edema (PME) in patients with stable diabetic retinopathy without significant macular edema. Methods: Eighty patients with cataract, stable diabetic retinopathy, and no significant macular edema were randomized to a sham group (cataract surgery only) or a group undergoing cataract surgery plus intraoperative ranibizumab injection. Best-corrected visual acuities, central subfield thickness, and total macular volume were assessed at baseline and 1 week, 1, 3, and 6 months postoperatively by spectral domain optical coherence tomography. Clinically meaningful PME (central subfield thickness increase >60 &mgr;m relative to baseline) was computed. Results: The groups did not differ in baseline best-corrected visual acuity, central subfield thickness, and total macular volume. Compared with the ranibizumab injection group, the sham group had significantly larger central subfield thickness increases relative to baseline at 1 week and 1 month; larger total macular volume increases at all time points (P = 0.012, P = 0.005, P < 0.001, P < 0.001, P = 0.005, P = 0.017, respectively); higher PME frequency at 1 month (P = 0.019); and poorer best-corrected visual acuity improvement from baseline to 6 months after surgery (P = 0.046). Conclusion: In patients with stable diabetic retinopathy without significant macular edema, intravitreal ranibizumab injection at cataract surgery may prevent the postoperative worsening of macular edema and may improve the final visual outcome without affecting safety.

Structural Recovery of the Detached Macula after Retinal Detachment Repair as Assessed by Optical Coherence Tomography

Purpose To investigate correlations between preoperative and postoperative foveal microstructures in patients with macula-off rhegmatogenous retinal detachment (RRD). Methods We reviewed the records of 31 eyes from 31 patients with macula-off RRD who had undergone successful re-attachment surgery. We analyzed data obtained from complete ophthalmologic examinations and optical coherence tomography (OCT) before and 9 to 12 months after surgery. All postoperative OCT measurements were taken with spectral-domain OCT, but a subset of preoperative OCT measurements were taken with time-domain OCT. Results The mean duration of macular detachment was 15.5 ± 15.2 days, and mean preoperative best-corrected visual acuity (BCVA, logarithm of the minimum angle of resolution) was 1.03 ± 0.68. Preoperative visual acuity was correlated with retinal detachment height (p < 0.001) and the existence of intraretinal separation (IRS) along with outer layer undulation (OLU) (p = 0.022), but not with macula-off duration. The final BCVA was significantly correlated with integrity of the junction between the photoreceptor inner and outer segments (IS/OS) combined with the continuity of external limiting membrane (ELM) (p = 0.025). The presence of IRS and OLU on a detached macula were highly correlated with the final postoperative integrity of the IS/OS junction and the ELM (p = 0.017). Conclusions Eyes preoperatively exhibiting IRS and OLU showed a higher incidence of disruption to the photoreceptor IS/OS junction and the ELM at final follow-up. Such a close correlation between preoperative and postoperative structural changes may explain why ultimate visual recovery in such eyes is poor.

Assessment of metamorphopsia in patients with central serous chorioretinopathy

Background: To evaluate the presence and extent of metamorphopsia using M-CHARTS™ (Inami Co., Tokyo, Japan) in patients with central serous chorioretinopathy (CSC). Design: Retrospective consecutive medical record review in a university hospital. Materials and Methods: We examined 33 eyes of 33 consecutive CSC patients using M-CHARTS, which yields scores reflecting the severity of metamorphopsia. The condition was considered present when an M-CHARTS score was 0.3 or over. In all patients, optical coherence tomography (OCT) was performed, best-corrected visual acuity (BCVA) was assessed, and M-CHARTS scores were calculated at the first and the 1- and 3-month follow-up visits. The correlation between M-CHARTS scores and BCVA values was determined. We also sought to define relationships between the level of metamorphopsia and specific OCT findings. Results: Of 33 CSC patients, 15 showed symptoms of metamorphopsia, and all 15 had M-CHARTS scores of over 0.3. However, no correlation was evident between BCVA values and the extent of metamorphopsia as determined using M-CHARTS. In metamorphopsia patients, the incidence of focal retinal pigment epithelial detachment was notably greater than in the non-metamorphopsia group (P = 0.03). Conclusion: M-CHARTS is valuable for monitoring subjective symptom improvement during the clinical course of CSC. M-CHARTS serves as a useful adjunct to OCT.

Central Photoreceptor Viability and Prediction of Visual Outcome in Patients with Idiopathic Macular Holes

Purpose To identify the correlation between preoperative optical coherence tomography (OCT) features and postoperative visual outcomes in eyes with idiopathic macular holes (MHs). Methods Data from 55 eyes with idiopathic MHs which had been sealed by vitrectomy were retrospectively reviewed. Correlation analysis was conducted between postoperative visual acuity (Vpostop, logarithm of the minimum angle of resolution [logMAR]) and preoperative factors, including four OCT parameters: the anticipated length (A) devoid of photoreceptors after hole closure, MH height (B), MH size (C), and the grading (D) of the viability of detached photoreceptors. Additionally, the formula for the prediction of visual outcome was deduced. Results Vpostop was determined to be significantly correlated with the preoperative visual acuity (Vpreop) and OCT parameters A, C, and D (p<0.001). Based on the correlation, the formula for the prediction of Vpostop was derived from the most accurate regression analysis: Vpostop=0.248×Vpreop+1.1×10-6×A2-0.121×D+0.19. Conclusions The length and viability of detached photoreceptors are significant preoperative OCT features for predicting visual prognosis. This suggests that, regardless of the MH size and symptom duration, active surgical intervention should be encouraged, particularly if the MH exhibits good viability in the detached photoreceptor layer.

Macular Gradient Measurement in Myopic Posterior Staphyloma Using Optical Coherence Tomography

Purpose To evaluate clinical characteristics and the macular gradient in myopic posterior staphyloma with time domain (TD) optical coherence tomography (OCT). Methods Sixty-four staphyloma eyes of 40 patients were examined. Macular gradient (tangent θ) and the location of staphyloma were assessed with OCT imaging. The macular gradient was measured at points 1 mm and 2 mm distant from the fovea. The relationships of the macular gradient with age, axial length, and spherical equivalent were analyzed. Results In 8 eyes (12.5%), the bottoms of the staphylomas were in the fovea, and there was no macular gradient. However, in the other 56 eyes (87.5%), the bottoms of the staphylomas were not in the foveal area, and macular gradients existed. Staphylomas were commonly located in the infero-nasal retinal area. The mean macular gradient (tangent θ) was 0.26 ± 0.08 at 1 mm distance from the fovea and 0.28 ± 0.10 at 2 mm. No significant relationships were observed between macular gradient and axial length, patient age, or spherical equivalent. Conclusions TD OCT reveals staphyloma location. If the location is outside of the fovea, a macular gradient exists and can be measured by OCT. Axial length measurement error may occur in eyes with poor visual fixation and steep macular gradients.

Time-lag between subretinal fluid and pigment epithelial detachment reduction after polypoidal choroidal vasculopathy treatment.

Purpose The goal of the present research was to study post-treatment changes in polypoidal choroidal vasculopathy (PCV) shown by optical coherence tomography (OCT). Methods The study included 12 patients with naive PCV. Photodynamic therapy and 3 consecutive intravitreal bevacizumab injections at 6-week intervals were given. Best corrected visual acuity, subretinal fluid (SRF), pigment epithelium detachment (PED), central macular thickness (CMT), and total macular volume (TMV) were measured before and after treatment as assessed by Stratus OCT3. Results After treatment, the SRF height decreased earlier than the PED height. The SRF diameter decreased with statistical significance. However, the PED diameter did not show a statistically significant improvement, persisting at pre-treatment levels. Both CMT and TMV decreased significantly after treatment. Conclusions After PCV treatment, SRF and PED stabilized, as shown by OCT. However, the PED treatment response was both delayed and refractory compared to the SRF response. The small change in post-treatment PED diameter may suggest the possibility of PCV recurrence.

Valsalva retinopathy and branch retinal artery occlusion after cardiopulmonary cerebral resuscitation

We report a 53-year-old woman who had acute visual loss 10 days after cardiopulmonary cerebral resuscitation performance. Immediately after she had performed cardiopulmonary cerebral resuscitation, she developed floater symptoms in her left eye, which persisted for 2 hours, and she was diagnosed as having Valsalva retinopathy. Ten days later, she had an acute painless visual loss in the same eye (visual acuity 20/1000). On fundus examination, optic disk edema, peripapillary hemorrhage, and retinal artery occlusion were detected in the superior half of her left retina and she was diagnosed as having branch retinal artery occlusion. Four months later, her visual acuity had increased to 20/40; however, the inferior altitudinal visual field defect remained. To rule out cardiac associations of branch retinal artery occlusion, transesophageal echocardiography was performed and a patent foramen ovale on her atrial septum was detected. This case indicates a possible risk that emergency medical personnel could have medical problems while performing strenuous tasks to help other people.

Axial length measurement in silicone oil-filled eyes using laser Doppler interferometry.

Measurement of axial length in silicone oil–filled eyes using A-mode echography is inaccurate because the speed of sound in silicone oil is half of that in air.1 The increased use of silicone oil tamponade in vitreoretinal surgery has led to a rapid increase in cases requiring a combined procedure of silicone oil removal and cataract extraction with intraocular lens implantation. 2–4 Although fellow eye measurements, converting A-scan measurement calculations, and computed tomography measurements are suggested for use in determining axial length, all these methods have limitations. 1–4

Association Between Hyperreflective Dots on Spectral-Domain Optical Coherence Tomography in Macular Edema and Response to Treatment

Purpose To investigate the association between hyperreflective dots (HRDs) on spectral-domain optical coherence tomography (SD-OCT) and response to intravitreal bevacizumab (IVB) or dexamethasone injection in eyes with diabetic macular edema (DME) or macular edema due to retinal vein occlusion (RVO). Methods A retrospective review was conducted involving patients with DME or macular edema due to RVO. Patients with treatment-naïve macular edema were initially treated with three consecutive IVB injections and classified based on the treatment response to bevacizumab. After three consecutive IVB injections, bevacizumab nonresponders were treated using dexamethasone implants and reclassified based on the treatment response. The best-corrected visual acuity, number of HRDs, and outer plexiform layer (OPL) disruptions were analyzed according to the treatment response. Results Eighty-two eyes with DME and 68 eyes with RVO were included in this study. Thirty-six (43.9%) eyes with DME and 22 (32.4%) eyes with RVO were bevacizumab nonresponders. The number of baseline HRDs in bevacizumab nonresponders (16.06 ± 6.60 in DME, 14.23 ± 4.09 in RVO) was significantly greater than that in responders (11.26 ± 3.64, P < 0.001 in DME, 11.17 ± 4.83, P = 0.013 in RVO), and it did not decrease after IVB injections. Unlike the response to bevacizumab, eyes that responded to dexamethasone implant but not to IVB had significantly more HRDs (19.56 ± 6.75) than eyes that did not respond (11.50 ± 3.78, P = 0.006). The OPL disruption rate was significantly higher in bevacizumab nonresponders than in responders (P < 0.001 in DME and P = 0.001 in RVO). Conclusions In patients with DME or macular edema due to RVO, the number of HRDs on SD-OCT may be a predictive indicator of the response to IVB injection or dexamethasone implant. In bevacizumab responders, the number of HRDs on SD-OCT was small. In contrast, more HRDs, which might reflect increased inflammation in the retina, were observed in dexamethasone responders. Therefore, dexamethasone implants might be more effective in DME or RVO eyes with multiple HRDs and OPL disruption on SD-OCT.