Wan-Chen Ku

Secondary Ocular Hypertension After Intravitreal Injection with 2 mg or 4 mg of Triamcinolone in Retinal Vein Occlusion

PURPOSE To evaluate secondary ocular hypertension after intravitreal injection of triamcinolone acetonide (IVTA) with 2 mg/0.05 mL or 4 mg/0.1 mL for macular edema associated with retinal vein occlusion (RVO). METHODS A retrospective chart review was performed. Patients with RVO, including central RVO and branch RVO, were divided into 2 groups. Group 1 was patients who received 2 mg IVTA and group 2 received 4 mg IVTA. The dose of IVTA was dependent on individual surgeons decision. Secondary ocular hypertension was defined as intraocular pressure (IOP) >21 mmHg. Long-term antiglaucoma medication referred to eyes that required antiglaucoma agents for >6 months. RESULTS Thirty-six eyes in group 1 and 32 eyes in group 2 were included in the analyses. The mean age of all the patients was 58.6 years, and 52.9% of patients were men. The mean follow-up period was 12.4 months. A wide range (from day 7 to month 8) of time until the onset of the IOP spike was recorded after the injection. The incidence of secondary ocular hypertension was not significantly different between group 2 and group 1 (38.9% vs. 50%, P = 0.36). However, group 2 had a higher proportion of long-term antiglaucoma medication usage than group 1 (5.6% vs. 40.6%; Pearson chi-square, P < 0.001). Ultimately, 2.9% of patients underwent filtration surgery. Macular edema diminished and best-corrected visual acuity improved at 3 months later in both groups. CONCLUSIONS With a similar effect on vision recovery and alleviating macular edema associated with RVO, 2 mg IVTA required a shorter duration of medical control for secondary ocular hypertension than 4 mg IVTA.

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.

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.

Contact dermatitis on the lower eyelid related to tick infestation: A case report in Taiwan

Tick bite on the lower eyelid is a rare condition. We reported a case of contact dermatitis on the lower eyelid related to the tick infestation. Ticks are vectors for disease transmission. Symptoms and treatments for tick-borne diseases were reviewed.

Hypotony Maculopathy after 23-Gauge Transconjunctival Sutureless Vitrectomy: A Case Report

Purpose: To describe a case of hypotony maculopathy following 23-gauge transconjunctival sutureless vitrectomy. Methods: A case report and literature review. Results: A 39-year-old man had penetrating injury of his left eye by a piece of iron. Scleral perforation, intraocular foreign body, traumatic cataract, retinal break and retinal vessel occlusion were noted during initial examination. He received emergent surgery of the scleral wound, 20-gauge pars plana vitrectomy, lensectomy and removal of the intraocular foreign body, followed by 23-gauge sutureless vitrectomy and secondary intraocular lens implantation 10 weeks later. His preoperative best corrected visual acuity was 0.3 and the intraocular pressure (IOP) was 8 mmHg. However, IOP decreased to 4 mmHg on the postoperative day 6. Fundus examination showed retinal vascular tortuosity and choroidal folds. He was treated with prednisolone acetate 1% four times a day. The IOP spontaneously returned to 15 mmHg 3 weeks after the operation. His best corrected visual acuity gradually improved to 1.0 at the 11th week. Conclusions: Postoperative hypotony following sutureless vitrectomy is not uncommon, and usually resolves spontaneously without other complications. Young age and a previous vitrectomy are risk factors related to postoperative hypotony. However, postoperative hypotony maculopathy is an uncommon complication. Our patient had persistent hypotony following a 23-guage sutureless vitrectomy complicated by hypotony maculopathy. It resolved spontaneously after conservative treatment.