Yong Soo Byun

Complications and Safety Profile of Posterior Subtenon Injection of Triamcinolone Acetonide

PURPOSE Posterior subtenon injection (PSTI) of triamcinolone acetonide (TA) is one of the delivery methods for the treatment of posterior uveitis, diabetic macular edema, and cystoid macular edema secondary to retinal vein occlusions. The aim of this investigation was to assess the rates of various complications associated with PSTI and to determine which factors are associated with the development of complications. METHODS This investigation was a retrospective interventional case series, and one retinal specialist from 2005 to 2007 conducted all of the procedures. Patients were followed up for a mean time of 11.9 +/- 5.4 months after receiving 40 mg (1.0 mL) of nonfiltered TA and all complications associated with the injection procedure or with TA itself were noted. RESULTS A total of 159 eyes in 158 patients were treated by PSTI of TA. Of 159 eyes, 145 eyes (91.2%) were injected once, 13 eyes (8.2%) were injected twice, and one eye (0.6%) was injected three times. The mean age of the 158 patients was 61.6 +/- 9.5 years. Eighteen eyes (11.3%) required glaucoma medication due to increased intraocular pressure (IOP) after injection. In addition, cataracts in three eyes (2.1%) progressed with biomicroscopic findings, as compared with the fellow eyes. There were no cases of mechanical injury, infection or ulceration of any part of eye, and eyelid complications. A conjunctival cyst at the injection site developed in one eye. CONCLUSIONS In this study, PSTI of TA resulted in no severe complications such as endophthalmitis or retinal detachment, and a relatively less risk of IOP complications and cataract progression. PSTI of TA is an extremely safe procedure and can be repeatedly applied to an eye.

Comparison of Postoperative Refractive Outcomes: IOLMaster® Versus Immersion Ultrasound

BACKGROUND AND OBJECTIVE To compare the postoperative refractive outcomes between IOLMaster biometry (Carl Zeiss Meditec, Inc., Dublin, CA) and immersion ultrasound biometry for axial length measurements. PATIENTS AND METHODS Refractive outcomes in 354 eyes were compared using the IOLMaster and the immersion ultrasound biometry. Predicted refraction was determined using manual keratometry and the SRK-T formula with personalized A-constant. RESULTS The axial lengths measured using the IOLMaster and immersion ultrasound were 24.49 ± 2.11 and 24.46 ± 2.11 mm, respectively, and the difference was significant (P < .05). The mean errors were 0.000 ± 0.578 D with the IOLMaster, and 0.000 ± 0.599 D with the immersion ultrasound, but the difference was not significant. The mean absolute error was smaller with the IOLMaster than with immersion ultrasound (0.463 ± 0.341 vs 0.479 ± 0.359 D), but the difference was not significant. CONCLUSION IOLMaster biometry yields highly accurate results in cataract surgery. However, if the IOLMaster is unavailable, immersion ultrasound biometry with personalized intraocular lens constants is an acceptable alternative.

Indocyanine Green Angiographic Findings of Obscure Choroidal Abnormalities in Neurofibromatosis

We report two cases of choroidal neurofibromatosis, detected with the aid of indocyanine green angiography (ICGA) in patients with neurofibromatosis (NF)-1, otherwise having obscure findings based on ophthalmoscopy and fluoresceine angiography (FA). In case 1, the ophthalmoscopic exam showed diffuse bright or yellowish patched areas with irregular and blunt borders at the posterior pole. The FA showed multiple hyperfluorescent areas at the posterior pole in the early phase, which then showed more hyperfluorescence without leakage or extent in the late phase. The ICGA showed diffuse hypofluorescent areas in both the early and late phases, and the deep choroidal vessels were also visible. In case 2, the fundus showed no abnormal findings, and the FA showed weakly hypofluorescent areas with indefinite borders in both eyes. With the ICGA, these areas were more hypofluorescent and had clear borders. Choroidal involvement in NF-1 seems to occur more than expected. In selected cases, ICGA is a useful tool to be utilized when an ocular examination is conducted in a patient that has no definite findings based on the ophthalmoscope, B-scan, or FA tests.