Yeoung Geol Park

Intravitreal Triamcinolone Reduces the Morphologic Changes of Ciliary Body After Pars Plana Vitrectomy for Retinal Vascular Diseases

PURPOSE To investigate the early postoperative changes in ciliary body after pars plana vitrectomy (PPV) for retinal vascular disease and to determine whether intravitreal triamcinolone acetonide (IVTA) affects postvitrectomy changes of the ciliary body. DESIGN Prospective interventional case-control study. METHODS We recruited 46 patients who underwent uncomplicated PPV for retinal vascular disease (35 with proliferative diabetic retinopathy (PDR) and 11 with branch retinal vein occlusion) and divided the patients into two groups according to the use of IVTA at the end of the PPV. The morphologic changes of the anterior segments were measured by ultrasound biomicroscopy (UBM) one day before and one day, two days, three days, five days, two weeks, one month, and two months after the PPV. The main outcome measures were the thickness and area of the ciliary body, the frequency of supraciliary effusions (SEs), angle-opening, and anterior chamber depth (ACD). We compared the UBM parameters between the two groups. RESULTS The thickness and area of the ciliary body significantly increased from day 1 to day 5 postoperatively. Nineteen of 46 eyes had SEs that were frequently associated with divergent alterations of postoperative intraocular pressure (IOP). The angle-opening and ACD were significantly decreased and dependent upon the findings of ciliary body thickness and SEs. The degree of the morphologic changes of the ciliary body and the frequency of SEs were significantly lower and of shorter duration in the IVTA group compared to the non-IVTA group. CONCLUSIONS The PPV for retinal vascular disease induces the morphologic changes of the ciliary body associated with postoperative abnormalities in IOP during the early postoperative period. Administration of IVTA at the end of the PPV effectively reduces or shortens the duration of the postvitrectomy changes of the ciliary body.

An Epidemic of Chronic Pseudophakic Endophthalmitis Due to Ochrobactrum anthropi: Clinical Findings and Managements of Nine Consecutive Cases

Purpose: To report an epidemic of O. anthropi pseudophakic endophthalmitis. Methods: The medical records of nine patients with culture-proven O. anthropi endophthalmitis were reviewed. Results: The presenting features were compatible to chronic endophthalmitis. Two patients showed coinfections with P. acnes. Antibiotics sensitivity test revealed susceptibility to quinolones. Pars plana vitrectomy (PPV) with partial capsulectomy (PC) cured infections in seven patients without coinfection of P. acnes. Final visual acuity was 20/40 or better in five patients. Conclusions: O. anthropi should be considered in cases with chronic pseudophakic endophthalmitis. PPV with PC should be the initial therapeutic option for O. anthropi endophthalmitis.

Histopathological Study of Frontalis Suspension Materials

PURPOSE This study is designed to find the most suitable frontalis suspension material by comparing the histopathologic findings of frequently used suspension materials in vivo. METHODS Three kinds of suspension materials-autologous fascia lata, 1-0 Prolene suture material, and Silicone Band-were implanted in the white rabbit. Histopathologic study was done sequentially 1 week, 2 weeks, 4 weeks, and 8 weeks after implantation. RESULTS Histologically, autologous fascia lata showed less inflammatory reaction and better incorporation with surrounding structures than the Silicone Band and suture material. Suture material and Silicone Band showed marked inflammatory reaction and did not incorporate or tightly bond with surrounding tissue in any of the samples. CONCLUSIONS Fresh autologous fascia lata appears to be the most suitable material for frontalis suspension after histopathological testing.

A New Technique for Repositioning a Posteriorly Dislocated Intraocular Lens

Pars plana vitrectomy was performed to treat a complete posterior dislocation of an intraocular lens in seven patients. The method that the authors have developed appears to be safer and simpler than those previously described. The haptics are externalized for a secure tie at the proper site, and are then reinternalized back through the pars plana sclerotomies. Only two small needle perforations are made for the scleral fixation of the intraocular lens in the ciliary sulcus. Perfluorocarbon liquid is used to prevent intraoperative retinal damage.

Anomalous Scleral Insertion of Superior Oblique in Axenfeld-Rieger Syndrome

Axenfeld-Rieger syndrome (ARS) is associated with ocular and systemic anomalies. PITX2 is known to be a major controlling gene in the pathogenesis of ARS and is associated with differentiation in both the neural crest and mesoderm during eye development. A 4-year-old girl with bilateral ARS had 20 prism diopters (PD) of exotropia with 30PD of A- pattern deviation, more than 20PD of dissociated vertical deviation (DVD), and severe superior oblique overaction (SOOA). During surgery we observed that the SO inserted more posteriorly than normal. We believe this finding is one of the abnormal manifestations of the development of the extraocular muscles in ARS.

Brown Syndrome with Bifid Scleral Insertion of the Superior Oblique

The authors describe a patient with bilateral congenital Brown syndrome who had bifid scleral insertion of the superior oblique muscle of both eyes. They considered bifid scleral insertion of the superior oblique muscle as a possible cause of congenital Brown syndrome.

Effect of 10-mm Superior Oblique Posterior Tenectomy Combined with Frenulum Dissection in A-Pattern with Superior Oblique Overaction

PURPOSE To evaluate the effect of 10-mm tenectomy of the posterior fibers of the superior oblique (SO) tendon combined with dissection of the frenulum for correction of A-pattern deviation and vertical deviation with SO overaction. DESIGN Retrospective, interventional case series. METHODS Seventy-five patients with A-pattern strabismus associated with SO overaction who underwent surgery between March 1, 2004 and August 31, 2007. Retrospective analysis of A-pattern strabismus patients with SO overaction who underwent unilateral or bilateral 10-mm SO posterior tenectomy combined with frenulum dissection and who underwent at least 12 months of follow-up. RESULTS The mean preoperative amount of A-pattern for all patients was 21.20 +/- 7.25 prism diopters (PD), with a mean postoperative collapse of 17.63 +/- 5.33 PD (range, 10 to 30 PD), which was statistically significant (P = .001). After surgery, the mean A-pattern correction was 22.12 +/- 6.30 PD in the group that underwent bilateral posterior tenectomy and 13.33 +/- 5.20 PD in the group that underwent unilateral posterior tenectomy. The mean degree of preoperative vertical deviation in the group that underwent unilateral posterior tenectomy was 11.50 +/- 3.96 PD, and the mean correction was 9.21 +/- 4.22 PD (P = .01). There were no surgical complications, except in 5 patients, who manifested mild inferior oblique overaction. CONCLUSIONS We believe that 10-mm SO posterior tenectomy combined with frenulum dissection effectively collapses A-pattern deviation of less than 25 PD with mild to moderate SO overaction and reduces associated vertical deviation of 10 PD.

Macular nerve fiber layer thickness.

Dear Editor: We read with interest the article by Huynh et al in the September 2009 issue on the subject of amblyopia and macular thickness. 1 The authors showed that the central macular thickness may be increased in eyes with amblyopia. They suggested that these differences in macular nerve fiber (NFL) thickness are due to the arrest of normal postnatal reduction (apoptosis) of retinal ganglion cells. However, their suggested explanation does not explain this result because the arrest of apoptosis of retinal ganglion cells should increase not only macular thickness but also, the peripapillary NFL thickness. Many reported studies have shown that differences in the visual performance between the eyes are associated with an anatomic cause, such as in the visual cortex or macular NFL thickness. In addition to peripapillary NFL thickness, macular thickness has been shown to be an important objective parameter for the detection of glaucoma. Loss of ganglion cell bodies (stacked up to 6 cell layers high) in the paramacular region results in significant thinning of this particular area of the retina. Amblyopia is generally attributed to abnormal development of the visual cortex. However, some have suggested that some eyes diagnosed with amblyopia may also have abnormalities in the afferent visual system anterior to the striate cortex, including the retina, retinal ganglion cell, retinal NFL, optic nerve, and lateral geniculate body of the thalamus. Ocular dominance is related to the effect of experience and deprivation of cortical development, and is manifested as shifts in the relative strength of binocular inputs to the primary visual cortex. In the mouse model, there is gross disparity in the visual system between the physiological strength of each eye in the visual cortex and their anatomical representation in the projections from the retina to the dorsal lateral geniculate nucleus. Although there have been several studies on macular NFL thickness using optical coherence tomography measurements in patients with glaucoma and amblyopia, there are no studies in patients with strabismus. Thus, we investigated the relationship between the macular NFL thickness in the dominant and contralateral eyes, according to the sensory status of the intermittent exotropia with strong unilateral ocular dominance. All patients showed less than a 2 lines of difference on the Snellen eye chart and 0.5 D difference of the spherical equivalent between the dominant and contralateral eye. The macular NFL thickness was estimated in 184 eyes of 92 patients ranging in age from 4–10 years (mean standard deviation, 6.89 2.09 years) by a Stratus OCT 3000 (Carl Zeiss, Dublin, CA) fast-scan protocol. Ninety-six eyes from the 48 patients (52%), ranging in age from 4–10 years (mean standard deviation, 7.08 1.38 years) met the criteria for fusion and 88 eyes from 44 patients (48%), ranging in age from 4–10 years (mean standard deviation, 6.40 2.15 years) met the criteria for suppression of the nondominant eye. The average thickness of 9 subfields within 4 quadrants in each of 2 outer concentric circles (3 and 6 mm) outside the foveal central circle (1 mm) of the dominant eye was compared with that of the contralateral eye. In addition, the identical comparison was performed according to the sensory status using the Worth 4 dot test (fusion Vs suppression of nondominant eye) at far. We repeated the measurements at least 3 times for the alternative cover test to determine ocular dominance. The statistical analysis for the comparison of the macular NFL thickness between both eyes was performed with a paired t-test. P values 0.05 were considered to be statistically significant. There was no statistically significant difference in macular NFL thickness when the dominant eyes were compared with the contralateral eyes in all subfields (Table 1; available at http://aaojournal.org). There was also no statistically significant difference in patients with fusion (Table 2; available at http://aaojournal.org) and suppression (Table 3; available at http://aaojournal.org). Strabismus is known to be related with both morphological anomalies and abnormal connections from the retina and the cortex. Strabismus leads to binocular neural changes and to spatial vision deficits, especially at the cortical level. We investigated the anatomic difference of retinal NFL thickness between the dominant eye and the nondominant eye in patients with intermittent exotropia with strong unilateral ocular dominance. We found that there was no statistically significant difference in macular NFL thickness between the dominant and nondominant eyes in patients with intermittent exotropia.