Kyung Seek Choi

Delayed-onset retinal detachment after an intravitreal injection of ranibizumab for zone 1 plus retinopathy of prematurity

Intravitreal injection of bevacizumab has been shown to satisfactorily treat retinopathy of prematurity; nevertheless, the safety of antivascular endothelial growth factor therapy in children remains uncertain. We report a patient with bilateral, zone 1, stage 3 plus retinopathy of prematurity who was treated with combined laser photocoagulation and intravitreal ranibizumab injection and demonstrated full regression at 3 months after injection but then developed bilateral retinal detachments 1 month later.

Sudden unilateral visual loss after autologous fat injection into the nasolabial fold

A 27-year-old female presented with sudden visual loss of her right eye after receiving an autologous fat injection into the right nasolabial fold. Fundus examination of the right eye showed multiple whitish patchy lesions with macular edema. Fluorescein angiogram showed deterioration of choroidal circulation with patchy choroidal filling and arm-to-retina circulation time and retinal arteriovenous passage time were delayed to 30 seconds and 20 seconds, respectively. There was no response in flash visual evoked potential (VEP). High dose steroid therapy (methylprednisolone 1 g/day/i.v.) was done and about 2 weeks later, the disc edema subsided and retinal arteriovenous passage time of fluorescein angiogram was normalized but there was no improvement in visual acuity. Absence of a cherry red spot, deterioration of choroidal circulation with patchy choroidal fillings seen in fluorescein angiogram, and no response in flash VEP suggests multiple choroidal infarction due to perfusion defect of the short posterior ciliary artery. The autologous fat injected is thought to have entered the dorsal nasal artery and the retrograde migration of the emboli to the ophthalmic artery might have caused the multiple occlusions of the short posterior ciliary artery.

Surface calcification of hydrophilic acrylic intraocular lens related to inflammatory membrane formation after combined vitrectomy and cataract surgery

UNLABELLED Two patients complained of blurred vision approximately 6 months after having combined vitrectomy and phacoemulsification with implantation of a C-flex 570C hydrophilic acrylic intraocular lens (IOL). Multiple granules were noted on the anterior surface of the IOLs in both patients. Intraocular lens exchange was performed in both eyes, and the explanted IOLs were sent for histopathological analysis. Scanning electron microscopy confirmed the presence of cracks and granules on the IOL surfaces and energy-dispersive x-ray spectroscopy demonstrated calcium deposition. Based on the calcification pattern on the anterior surface of the IOLs, 2 additional cases of opacification were identified under slitlamp examination. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.

Laser Photocoagulation Combined with Intravitreal Triamcinolone Acetonide Injection in Proliferative Diabetic Retinopathy with Macular Edema

Purpose To evaluate therapeutic effects and usefulness of a combination treatment of intravitreal injection of triamcinolone acetonide (IVTA) and panretinal photocoagulation (PRP) in patients with clinically significant macular edema secondary to proliferative diabetic retinopathy (PDR). Methods Visual acuity test, fundoscopy, fluorescein angiography, and optical coherence tomography (OCT) were taken in 20 patients (20 eyes) of macular edema and PDR. A combination of intravitreal injection of triamcinolone acetonide and PRP was performed in 10 patients (10 eyes) and a combination of focal or grid laser photocoaqulation and PRP in the remaining 10 eyes. The postoperative outcomes were compared between the two combination treatments by best corrected visual acuity (BCVA), tonometry, fluorescein angiography, and OCT at 2 weeks, 1, 2, and 3 months. Results Average BCVA (log MAR) significantly improved from preoperative 0.56±0.20 to 0.43±0.08 at 1 month (P=0.042) and it was maintained until 3 months after a combination of IVTA and PRP in 10 eyes (P=0.007). The thickness of fovea decreased from average 433.3±114.9 µm to average 279.5±34.1 µm at 2 weeks after combined treatment of IVTA and PRP (P=0.005), which was significantly maintained until 3 months, but there was a transient visual disturbance and no significant difference in thickness of the fovea before and after treatment in the groups with PRP and focal or grid laser photocoagulation. Conclusions A combination of IVTA and PRP might be an effective treatment modality in the treatment of macular edema and PDR and prevent the subsequent PRP-induced macular edema result in visual dysfunction. In combination with PRP, IVTA might be more effective than focal or grid laser photocoagulation and PRP for reducing diabetic macular edema and preventing aggravation of macular edema without transient visual disturbance in patients requiring immediate PRP.

Long-term surgical outcomes after vitrectomy for symptomatic lamellar macular holes.

Purpose: To determine long-term surgical findings and outcomes after vitrectomy for symptomatic lamellar macular holes. Methods: This is a retrospective, consecutive, interventional case series. Sixteen patients (31 eyes) with lamellar macular holes and central visual loss participated in the study. All patients underwent 3-port pars plana vitrectomy with membranectomy and/or internal limiting membrane peeling and gas tamponade under the care of one author. Best-corrected visual acuity and optical coherence tomography appearance were determined preoperatively and postoperatively. Results: Final visual acuity improved more than 2 lines postoperatively in 18 eyes (58.1%) and decreased in 2 eyes (6.5%) leading to a mean gain of 0.18 logarithm of the minimum angle of resolution visual acuity during the mean follow-up period of 39 ± 24 months (12–85 months). Twenty-eight eyes (90.3%) improved or normalized in foveal appearance on postoperative optical coherence tomography images of the macula, 1 eye remained unchanged, and 1 eye (3.2%) had chronic cystoid macular edema, 1 eye was unchanged, and 1 eye showed recurrence of lamellar macular hole. Conclusion: In patients with central visual loss from lamellar macular holes, vitrectomy, membranectomy, and/or internal limiting membrane peeling and gas tamponade appear to have a beneficial effect for a mean of 3 years.

Improving intraocular lens power prediction in combined phacoemulsification and vitrectomy in eyes with macular oedema

Purpose:  To report the accuracy of intraocular lens (IOL) power estimation in eyes that have undergone phacovitrectomy for retinal diseases with accompanying macular oedema.

Changes of Intraocular Pressure During Experimental Vitrectomy

Purpose: To compare the infusion pressure shown by a vitrectomy device with the actual intraocular pressure (IOP) observed during pars plana vitrectomy. Furthermore, we evaluated the effects of variable parameters on the actual IOP during vitrectomy surgery. Materials and methods: Porcine eyes were obtained within 24 h of slaughter. Actual IOP was measured by a digital manometer during vitrectomy using the vented gas forced infusion (VGFI) system, as well as the gravity system. We analyzed the actual IOP according to the groups divided by remnant volume of infusion fluid: (500 ml; control group, 250, 125, and 50 ml). Finally, actual IOP was determined after changing variable parameters such as cutting rate, vacuum pressure, and the VGFI setting. Results: Settings for a VGFI system and pressure supplied by a gravity system significantly correlated with actual IOP (r = 0.99, p = 0.0001; r = 0.99, and p = 0.0001). Actual IOP declined with decreasing volume of infusion fluid. If the volume of infusion fluid was <125 ml, actual IOP decreased significantly compared with the control group and the difference in actual IOP reflected a significant difference in the VGFI setting of 30 mmHg. Cutting rate as well as VGFI setting and vacuum pressure affected actual IOP. Conclusions: Infusion pressure shown by the vitrectomy device was similar to actual IOP in porcine eyes. However, volume of infusion fluid and variable parameters could change the actual IOP during pars plana vitrectomy. Our results may help to optimize the ideal parameters such as infusion pressure, vacuum pressure, and cutting rate of vitrectomy systems used to treat vitreoretinal diseases.

Intraocular lens exchange with removal of the optic only

PURPOSE: To evaluate the clinical outcomes of intraocular lens (IOL) exchange in patients with an opacified ACRL‐C160 intraocular lens (IOL) using an optic‐only removal technique. SETTING: Department of Ophthalmology, Soonchunhyang University Hospital, Seoul, Korea. METHODS: The study comprised eyes with previous phacoemulsification and implantation of a single‐piece hydrophilic acrylic IOL in the capsular bag and subsequent development of severe late opacification of the IOL. In all eyes, the IOL optic was explanted; any haptic with firm adhesions was left in the capsular bag. This was followed by placement of a new IOL. The perioperative complications were evaluated, and the best corrected visual acuity (BCVA) before surgery and after surgery was compared. RESULTS: Twenty‐three eyes of 20 patients were evaluated. Uneventful IOL exchange and placement of a new IOL in the bag was achieved in 9 eyes (39.1%) and in the sulcus in 13 eyes (56.5%), with posterior capsule rupture in 2 eyes (8.7%). One eye (4.3%) developed zonular dehiscence, and scleral IOL fixation was performed. The mean BCVA was 0.64 ± 0.35 logMAR before IOL exchange and 0.24 ± 0.20 logMAR after IOL exchange. During 41 months of follow‐up, 1 eye (4.3%) each was affected by recurrent anterior uveitis and delayed zonular dehiscence. The final mean BCVA was 0.38 ± 0.40 logMAR. There was no corneal decompensation or infectious keratitis. CONCLUSION: The optic‐only removal technique was a safe and helpful procedure that allowed recovery of visual acuity because it decreased the intraoperative complication of zonular dehiscence.

Sclerotomy Site Leakage According to Wound Shape in 23-Gauge Microincisional Vitrectomy Surgery

Purpose: To compare the shape and self-sealing nature of scleral incision sites according to bevel shape and trocar blade direction in 23-gauge microincisional vitrectomy surgery. Methods: Twenty-three-gauge microincisional vitrectomies were performed in 60 eyes using a single-step entry system (Alcon Surgical, USA) and a 23-gauge two-step Eckardt vitrectomy system (DORC, the Netherlands). Trocar cannula were inserted using trocar blades bevel-up (20 eyes) or bevel-down (20 eyes). In 20 eyes, trocars were inserted after sclerotomies were performed using a microvitreoretinal (MVR) blade. After removing the cannula, we compared the scleral wound shapes and looked for leakage. Results: A total of 180 sclerotomies were done: 60 in the bevel-up direction (group 1), 60 in the bevel-down direction (group 2), and 60 using an MVR blade (group 3). Bevel-up insertion produced a V-shaped sclerotomy wound, whereas bevel-down insertion produced a reverse V-shaped wound. The MVR blade produced a slit-shaped wound. Wound leakage was identified in 21 V-shaped wounds, seven reverse V-shaped wounds, and four slit-shaped wounds. We observed no cases of hypotony, vitreous incarceration, or endophthalmitis. Conclusions: The self-sealing effect of slit-shaped wounds and reverse V-shaped wounds was superior to that of V-shaped wounds.

Trends in diabetic retinopathy and related medical practices among type 2 diabetes patients: Results from the National Insurance Service Survey 2006–2013

The present study aimed to analyze the temporal changes in the prevalence, screening rate, visual impairments and treatment patterns of diabetic retinopathy in the Korean population over 8 years.