Ko-Jen Yang

Postcataract Endophthalmitis Caused by Enterococcus faecalis

Purpose: To investigate the management strategies, susceptibility patterns, and visual outcomes of postcataract Enterococcus faecalis endophthalmitis. Methods: Retrospective chart review study of 26 eyes of 26 patients with culture-proven E. faecalis endophthalmitis. Results: In initial treatments, pars plana vitrectomy with intravitreal antibiotics in 15 eyes (58%). Resistance patterns among the isolates were the following: vancomycin in 0 of 26 eyes (0%), ampicillin in 0 of 26 eyes (0%), teicoplanin in 0 of 18 eyes (0%), and high-level gentamicin (minimum inhibitory concentration > 500 mg/L) in 8 of 12 eyes (67%). Presenting visual acuity ranged from counting fingers to no light perception. Final visual acuity was better than 5/200 in 4 of 26 eyes (15%), 5/200 to hand motions in 4 of 26 eyes (15%), and light perception to no light perception in 18 of 26 eyes (69%). Conclusions: Although all E. faecalis isolates were susceptible to vancomycin, endophthalmitis caused by E. faecalis was usually associated with poor visual prognosis.

Reducing the incidence of early postoperative vitreous haemorrhage by preoperative intravitreal bevacizumab in vitrectomy for diabetic tractional retinal detachment

Acta Ophthalmol. 2010: 88: 635–640

Associations between chronic glycosylated haemoglobin (HbA1c) level and macular volume in diabetes patients without macular oedema

Acta Ophthalmol. 2010: 88: 753–758

Association between severity of vitreous haemorrhage and visual outcome in primary rhegmatogenous retinal detachment

Purpose:  To elucidate the relationship between the severity of vitreous haemorrhage (VH) and visual outcome in primary rhegmatogenous retinal detachment (RRD) without previous vitreoretinal surgery.

Obtained Mydriasis in Long-Term Type 2 Diabetic Patients

PURPOSE The purpose of this study was to evaluate obtained mydriasis and prevalence of small pupil in long-term type 2 diabetic patients. METHODS A prospective observational cross-sectional study was carried out. We included 107 eyes from 107 patients (mean age: 60.8) with long-term (≥10 years) type 2 diabetes mellitus. Patients were divided into 2 groups: no apparent diabetic retinopathy (group 1, n=33) and diabetic retinopathy (group 2, n=74). Exclusion criteria were eyes with prior intraocular surgeries, presence of other ocular disorders that may affect iris, or any other condition that precludes the precise measurement of pupil size. Sixty eyes in 60 age-matched nondiabetic patients (mean age: 61.0) scheduled for routine fundoscopy exam were enrolled as control. We measured pupil diameter by pupil gauges at 40 min after instillation of eye drops (phenylephrine 10% and tropicamide 1%). Small pupil was defined as pupil diameter of 6 mm or less. RESULTS Mean pupil diameter was 8.07 mm [standard deviation (SD): 0.59 mm] in the control group, 7.46 mm (SD: 0.71 mm) in group 1, and 7.24 mm (SD: 0.83 mm) in group 2. Both group 1 (P<0.001) and group 2 (P<0.001) showed significant difference when compared with the control group. The incidences of small pupil were 1.9% in the control group, 6.1% in group 1, and 13.5% in group 2. When compared with control, group 2 showed significantly higher incidence of small pupil (P=0.023). CONCLUSIONS Long-term diabetic patients showed poorer response to pharmacological mydriasis than nondiabetic patients. Higher prevalence of small pupil size was found in patients with diabetic retinopathy.

Axial length and proliferative diabetic retinopathy.

Purpose. To determine the correlation between axial length and diabetic retinopathy (DR) in patients with diabetes mellitus for 10 years or more. Methods. This study was a prospective, observational, cross-sectional study. Patients with diabetes for 10 years or more were included. We excluded eyes with any other significant ocular disease or any prior intraocular surgery, except uncomplicated cataract surgery. Only one eye of each patient was included as the study eye. The severity of DR was graded as no DR, non-proliferative DR (NPDR), or proliferative DR (PDR). Axial length was measured by A-scan ultrasound (10 MHz Transducer, AL-2000 Biometer/Pachymeter; Tomey, Phoenix, AZ). Univariate logistic regression models were used to evaluate the relationship between the dependent variables (any DR, PDR) and all potential risk factors. Axial length and other factors with p value <0.1 were included in multivariate logistic regression models. Backward selection based on the likelihood ratio statistic was used to select the final models. Results. We included 166 eyes from 166 patients (93 female and 73 male; mean age, 68.8 years). The mean diabetes duration was 15.4 years. Fifty-four (32.5%) eyes had no DR, 72 (43.4%) eyes had NPDR, and 40 (24.1%) eyes had PDR. In univariate analysis, hypertension (p = 0.009), renal impairment (p = 0.079), and insulin use (p = 0.009) were associated with developing any DR. Hypertension (p = 0.042), renal impairment (p = 0.014), insulin use (p = 0.040), pseudophakia (p = 0.019), and axial length (p = 0.076) were associated with developing PDR. In multivariate analysis, hypertension (p = 0.005) and insulin use (p = 0.010) were associated with developing any DR. Hypertension (p = 0.020), renal impairment (p = 0.025), pseudophakia (p = 0.006), and axial length (p = 0.024) were associated with developing PDR. Conclusions. This observational study suggests an inverse relationship between axial length and the development of PDR in patients with diabetes for 10 years or more. No relationship was found between axial length and the development of any DR.

Posttraumatic neovascularization in a cataractous crystalline lens

A 73-year-old woman presented with a dense traumatic cataract and intralens angiogenesis. Slitlamp examination showed abundant blood vessels in the lens stroma. Microscopic examination confirmed the presence of blood cells in the lumen. The angiogenesis represented an ingrowth into the lens from posterior synechias. Pathologic angiogenesis is frequently seen in the retina, vitreous, iris, and cornea but is rarely seen in the crystalline lens. This is the first well-documented case of angiogenesis in the lens stroma.

PERSISTENT CORNEAL EPITHELIAL DEFECT AFTER PARS PLANA VITRECTOMY.

Purpose: To investigate the incidence, risk factors, and clinical course of persistent corneal epithelial defects (PCED) after pars plana vitrectomy (PPV). Methods: The charts of 426 consecutive patients (511 eyes) who received PPV from January 2008 to December 2011 were reviewed. Corneal complications were defined as the presence of corneal epithelial defects, corneal edema, or superficial punctate keratopathy at least 1 week after vitrectomy. The PCED was defined as corneal epithelial defects lasting longer than 2 weeks after vitrectomy despite conventional treatment. The demographic, preoperative, intraoperative, and postoperative data were compared between PCED and non-PCED corneal complication groups to evaluate the risk factors and clinical outcomes. Results: Postoperative corneal complications developed in 103 of 460 (22.4%) eyes. Diabetes was associated with postoperative corneal epithelial defects (P = 0.021) and superficial punctate keratopathy (P = 0.022) but not corneal edema (P = 0.925). Among 103 eyes with corneal complications, 21 eyes developed PCED. The eyes with PCED had poor final visual acuity, with 23.8% (5/21) of the eyes in the PCED group having visual acuity of 20/200 or better compared with 51.2% (42/82) of the eyes in the non-PCED group (P = 0.024). Logistic regression analysis demonstrated that diabetes mellitus (P = 0.025), use of perfluoropropane (P = 0.001), and assistance of a first-year resident (P = 0.029) were statistically significant risk factors for PCED after PPV. There was also a high incidence of geographic herpes simplex virus epithelial keratitis among recalcitrant PCEDs lasting longer than 4 weeks (36%, 4/11 eyes). Conclusion: The overall incidence of PCED after PPV was 4.8%. Diabetes mellitus, intravitreal tamponade with perfluoropropane, and assistance of a first-year resident were risk factors for PCED after PPV. Persistent corneal epithelial defects after PPV were correlated with poor postoperative visual outcomes. Early and aggressive management is necessary for patients presenting with corneal epithelial defects after vitrectomy to prevent poor outcomes.

Paediatric retinal detachment: comparison of high myopia and extreme myopia

Aims: To compare the clinical features and surgical outcomes of paediatric retinal detachment (RD) in high myopia and extreme myopia. Methods: The clinical charts of 107 children who experienced RD and had a spherical equivalent (SE) of at least 6.00 dioptres (D) were reviewed. The patients were separated into a high myopia group (SE −6.0 to −10.0 D) and extreme myopia group (SE >−10.0 D). RD characteristics and outcomes were compared between these two groups. Results: There were significant differences between the two groups in total RD (p<0.001), the presence of posterior staphyloma (p<0.001) and some types of breaks. More eyes in the extreme myopia group required vitrectomy after the initial RD repair. In the high myopia group, retinal reattachment was achieved in 79 eyes (97.5%) at the end of the intervention, whereas in the extreme myopia group, retinal reattachment was achieved in 22 eyes (73.3%). Multiple logistic regression showed that a higher refractive error was the only negative predictor of surgical outcome (p = 0.026). Conclusion: Due to differences in aetiologies, clinical characteristics, required surgical procedure after initial repair, surgical and functional outcomes, paediatric RD with extreme myopia should be addressed differently from paediatric RD with high myopia.

Enteric-coated mycophenolate sodium as a corticosteroid-sparing agent for the treatment of autoimmune scleritis.

Purpose: To evaluate enteric-coated mycophenolate sodium (EC-MPS) as a corticosteroid-sparing agent in the treatment of autoimmune scleritis. Methods: A retrospective, interventional, noncomparative review of EC-MPS use in patients with autoimmune scleritis. Results: Seven eyes of 5 patients (all female; median age: 47 years, range: 20-55 years) with inflammatory scleral disease were treated with EC-MPS. The mean follow-up duration was 16.4 months (range, 12-20 months). EC-MPS was started at 360 mg twice daily. The mean time to treatment success was 1.6 months (range, 1-3 months). The mean prednisolone dosage at the onset of EC-MPS was 24 mg daily (range, 15-30 mg), and this was reduced to 6.5 mg daily (range, 0-10 mg) as inflammation control was achieved. No severe adverse events except for 1 patient with transient knee pain were reported; the incidence of adverse events after using EC-MPS was 1/6.83 person-years. There was no recurrence of scleral inflammation during the follow-up period. Conclusions: EC-MPS can be used as a corticosteroid-sparing agent to safely suppress inflammatory autoimmune scleritis.