Frosted branch angiitis as ocular manifestation of Behçet's disease: unusual case report and literature review

We report an unusual case of unilateral frosted branch angiitis associated with Behçet's disease, including a review of previously reported cases. A 39-year-old male with history of recurrent oral and genital ulcers presented with visual loss in his left eye. Fundus findings demonstrated occlusive retinal vasculitis resembling acute frosted branch angiitis. Laboratory examinations including viral markers revealed no abnormal findings except positive HLA-B51. The patient was treated with systemic steroid and cyclosporine. Six months after presentation, new oral ulcers and pseudofolliculitis appeared, and he was diagnosed with Behçet's disease following rheumatology consultation. During follow-up, there was no change in visual acuity of hand movement, and disc neovascularization developed even after complete panretinal photocoagulation. Ocular manifestations of Behçet's disease can present as unilateral frosted branch angiitis, and may consecutively involve in both eyes. Early immunosuppressive treatment is recommended.

Comparative study of corneal wetting agents during 25-gauge microincision vitrectomy surgery under a noncontact wide-angle viewing system

BACKGROUND AND OBJECTIVE

To compare the effects of corneal wetting agents during 25-gauge microincision vitrectomy surgery (MIVS) under a binocular indirect ophthalmic microscope system.

MATERIALS AND METHODS

This prospective, randomized, comparative study included 45 eyes undergoing 25-gauge MIVS. The randomly assigned corneal wetting agents were balanced salt solution, ProVisc, and DisCoVisc. The main outcome measures were the frequency of applications, the duration of each application, and the corneal surface status including corneal fluorescein staining score postoperatively.

RESULTS

The mean frequency of applications was higher for balanced salt solution (13.6 ± 4.3) than ProVisc (2.7 ± 1.0) or DisCoVisc (1.7 ± 0.5) (P < .001). The duration of each application was longer for DisCoVisc (29.8 ± 6.0 minutes) than balanced salt solution (3.7 ± 1.1 minutes) or ProVisc (17.6 ± 3.6 minutes) (P < .001). The fluorescein staining score was higher for balanced salt solution until 7 days postoperatively (P < .001).

CONCLUSION

ProVisc and DisCoVisc could be more effective corneal wetting agents than balanced salt solution by minimizing the frequency of intraoperative application and postoperative corneal injury.

Two-year results of AcrySof toric intraocular lens implantation in patients with combined microincision vitrectomy surgery and phacoemulsification

AIM

To evaluate the effects and stability of AcrySof toric intraocular lens (IOL) implantation in patients who had combined microincision vitrectomy surgery (MIVS) and phacoemulsification for vitreoretinal diseases and cataract with corneal astigmatism.

METHODS

A retrospective comparative study with 20 patients (20 eyes) who had combined 23-gauge MIVS and phacoemulsification with regular corneal astigmatism (>1.00 dioptres) was done. 10 eyes had toric IOL and 10 eyes had non-toric IOL implantation. The main outcome measures were uncorrected visual acuity (UCVA), refractive cylinder and toric IOL axis rotation at postoperative months 1, 6, 12, 18 and 24.

RESULTS

The mean UCVA of toric IOL was better than non-toric IOL at each postoperative period (p=0.019, 0.001, 0.007, 0.004 and 0.001, respectively). The mean absolute residual refractive cylinder of toric IOL was less than non-toric IOL at each postoperative period (p=0.001, <0.001, <0.001, <0.001 and <0.001, respectively). At month 24, the mean toric IOL axis rotation was 3.3 ± 2.1°, which was within 5° in 80% and within 10° in 100%.

CONCLUSIONS

Toric IOL implantation could be an effective method of correcting corneal astigmatism in patients who have vitreoretinal diseases and cataract. The toric IOL showed good rotational stability, even in vitrectomised eyes for 24 months.

Bilateral Nongranulomatous Uveitis with Infective Endocarditis

A 32-year-old male who had infective endocarditis complained of photophobia and blurred vision in both eyes. Biomicroscopic examination and fundus examination revealed anterior chamber reaction, vitritis, optic disc swelling, and Roth spots. He was diagnosed with bilateral nongranulomatous uveitis and treated with topical steroid eye drops and posterior sub-Tenon injection of triamcinolone. His visual symptoms were resolved within 1 week, and inflammation resolved within 4 weeks after treatment.

Two novel mutations in the EYS gene are possible major causes of autosomal recessive retinitis pigmentosa in the Japanese population

Retinitis pigmentosa (RP) is a highly heterogeneous genetic disease including autosomal recessive (ar), autosomal dominant (ad), and X-linked inheritance. Recently, arRP has been associated with mutations in EYS (Eyes shut homolog), which is a major causative gene for this disease. This study was conducted to determine the spectrum and frequency of EYS mutations in 100 Japanese arRP patients. To determine the prevalence of EYS mutations, all EYS exons were screened for mutations by polymerase chain reaction amplification, and sequence analysis was performed. We detected 67 sequence alterations in EYS, of which 21 were novel. Of these, 7 were very likely pathogenic mutations, 6 were possible pathogenic mutations, and 54 were predicted non-pathogenic sequence alterations. The minimum observed prevalence of distinct EYS mutations in our study was 18% (18/100, comprising 9 patients with 2 very likely pathogenic mutations and the remaining 9 with only one such mutation). Among these mutations, 2 novel truncating mutations, c.4957_4958insA (p.S1653KfsX2) and c.8868C>A (p.Y2956X), were identified in 16 patients and accounted for 57.1% (20/35 alleles) of the mutated alleles. Although these 2 truncating mutations were not detected in Japanese patients with adRP or Leber's congenital amaurosis, we detected them in Korean arRP patients. Similar to Japanese arRP results, the c.4957_4958insA mutation was more frequently detected than the c.8868C>A mutation. The 18% estimated prevalence of very likely pathogenic mutations in our study suggests a major involvement of EYS in the pathogenesis of arRP in the Japanese population. Mutation spectrum of EYS in 100 Japanese patients, including 13 distinct very likely and possible pathogenic mutations, was largely different from the previously reported spectrum in patients from non-Asian populations. Screening for c.4957_4958insA and c.8868C>A mutations in the EYS gene may therefore be very effective for the genetic testing and counseling of RP patients in Japan.

Prevalence of eye diseases in South Korea: data from the Korea National Health and Nutrition Examination Survey 2008-2009

PURPOSE

The aim of this study is to report on preliminary data regarding the prevalence of major eye diseases in Korea.

METHODS

We obtained data from the Korea National Health and Nutrition Examination Survey, a nation-wide cross-sectional survey and examinations of the non-institutionalized civilian population in South Korea (n = 14,606), conducted from July 2008 to December 2009. Field survey teams included an ophthalmologist, nurses, and interviewers, traveled with a mobile examination unit and performed interviews and ophthalmologic examinations.

RESULTS

The prevalence of visual impairment, myopia, hyperopia and astigmatism in participants over 5 years of age was 0.4 ± 0.1%, 53.7 ± 0.6%, 10.7 ± 0.4%, and 58.0 ± 0.6%, respectively. The prevalence of strabismus and blepharoptosis in participants over 3 years of age was 1.5 ± 0.1% and 11.0 ± 0.8%, respectively. In participants over 40 years of age, the prevalence of cataract, pterygium, early and late age-related macular degeneration, diabetic retinopathy and glaucoma was 40.2 ± 1.3%, 8.9 ± 0.5%, 5.1 ± 0.3%, 0.5 ± 0.1%, 13.4 ± 1.5%, and 2.1 ± 0.2%, respectively.

CONCLUSIONS

This is the first nation-wide epidemiologic study conducted in South Korea for assessment of the prevalence of eye diseases by both the Korean Ophthalmologic Society and the Korea Center for Disease Control and Prevention. This study will provide preliminary information for use in further investigation, prevention, and management of eye diseases in Korea.

Conjunctival pigmentation after 23-gauge microincisional vitrectomy surgery

AIM

To investigate cases with conjunctival pigmentation originating from sclerotomy sites after 23-gauge microincisional vitrectomy surgery (MIVS).

METHODS

This is a retrospective study comprised of 185 eyes from 185 consecutive patients who underwent 23-gauge MIVS. The authors investigated the incidence and the clinical factors associated with conjunctival pigmentation, including indication of vitrectomy and surgical procedures.

RESULTS

Eight eyes (4.3%) from 185 eyes showed conjunctival pigmentation after surgery within 7 days postoperatively. Light microscopic examination of excised tissue showed infiltration of abundant dark brownish colored melanophages with surrounding scattered, finely granular, melanin pigments. C3F8 gas tamponade (OR, 9.4; 95% CI, 1.9-44.5; P=0.005) was significantly associated with conjunctival pigmentation. The mean surface area (21.26±2.21 mm(2)) of three eyes with C3F8 tamponade was significantly larger than that of five eyes (2.51±0.73 mm(2)) without tamponade (P=0.025). Neither leakage nor hypotony was found.

CONCLUSIONS

Intraocular melanin pigments could prolapse through the sclerotomy site and cause conjunctival pigmentation after 23-gauge MIVS. Thus, preoperative warning is necessary in patients with 23-gauge MIVS.

A case of intravitreal bevacizumab injection for the treatment of choroidal neovascularization in angioid streaks

A 56-year-old Korean woman presented with decreased visual acuity of the right eye. She had a history of two photodynamic therapy treatments for choroidal neovascularization (CNV) due to angioid streaks in her left eye with central scarring and low visual acuity. She was diagnosed with subfoveal CNV due to angioid streaks in her right eye and treated with six intravitreal bevacizumab (1.25 mg / 0.05 mL) injections over one year. Best corrected visual acuity improved from 20 / 125 at baseline to 20 / 50 at the final visit. The area of CNV had changed into a fibrotic scar by the final visit, and fluorescein angiography and indocyanine green angiography revealed no evidence of leakage. Optical coherence tomography showed that central macular thickness decreased from 311 µm at baseline to 203 µm with complete resolution of subretinal and intraretinal fluid at the final visit. Intravitreal bevacizumab for CNV associated with angioid streaks prevented the progression of disease and resulted in the improvement of visual acuity after one year of follow-up in our patient.

Comparison of clinical outcomes between 23-gauge and 20-gauge vitrectomy in patients with proliferative diabetic retinopathy

PURPOSE

The purpose of this study was to compare the clinical outcomes and complications between 23-gauge transconjunctival sutureless vitrectomy and 20-gauge vitrectomy in patients with proliferative diabetic retinopathy.

METHODS

This is a retrospective comparative study comprising 101 eyes from 90 consecutive patients who had diabetic vitrectomy due to nonclearing vitreous hemorrhage. Thirty-five eyes underwent 23-gauge transconjunctival sutureless vitrectomy, and 66 eyes underwent 20-gauge vitrectomy. Main outcome measures were best-corrected visual acuity, intraocular pressure, and incidence of intraoperative and postoperative complications with at least 6 months of follow-up.

RESULTS

Best-corrected visual acuity of both groups at postoperative months 1, 3, and 6 significantly improved from the preoperative best-corrected visual acuity (P < 0.0001, respectively). There was no difference for best-corrected visual acuity between the 2 groups at each follow-up period (P > 0.05, respectively). Intraocular pressure of the 23-gauge group at postoperative Day 1 and Week 1 was less than the preoperative intraocular pressure (P < 0.0001 and 0.017). Operating time of the 23-gauge group was shorter than the 20-gauge group (P < 0.0001). There was no difference in the incidence of intraoperative and postoperative complications except transient postoperative hypotony, which occurred in 8 eyes (22.9%) from the 23-gauge group (P < 0.0001).

CONCLUSION

Twenty three-gauge transconjunctival sutureless vitrectomy appears to be as effective for proliferative diabetic retinopathy as 20-gauge vitrectomy.

Conjunctivolimbal autograft using a fibrin adhesive in pterygium surgery

Purpose

To evaluate the efficacy and safety of fibrin bioadhesive in conjunctivolimbal autograft surgery for primary pterygium.

Methods

Thirty-six eyes in 34 patients were reviewed with nasal primary pterygium who were treated with pterygium excision with superior conjunctivolimbal transplantation with fibrin bioadhesive. Surgical durations were recorded and the patients were followed up on the first day after surgery and then at 1, 2, 4, 8 and 12 weeks postoperatively. The graft-recipient site attachments were examined and subjective symptoms of patients were recorded at every follow-up examinations.

Results

The mean patient age was 57.9±10.1 (ranging from 33 to 83) years. The mean follow-up period was 22.05±5.78 weeks. The mean surgery time was 18.04±5.65 minutes. The subjective symptoms (pain, foreign body sensation, tearing and discomfort) disappeared in 23 of 36 eyes (64%) in one week after surgery, and all discomforts subsided within two weeks after surgery in all patients. The conjunctivolimbal autograft was correctly positioned and fixed in 34 of 36 eyes (94.4%) throughout the follow-up period. Graft dehiscence was seen in two eyes (5.6%), one eye was treated with remedial sutures, and the other eye showed a spontaneous healing without remedial sutures. Transient graft edema occurred in four eyes (11.2%) but subsided spontaneously within a month. There were no cases of pterygium regrowth or complications due to the fibrin bioadhesive.

Conclusions

The use of fibrin bioadhesive in conjunctivolimbal autograft surgery in primary pterygium simplifies surgical techniques, shorten surgical duration, and produce less postoperative subjective symptoms. Therefore, the fibrin bioadhesive is a safe and effective tool to attach conjunctivolimbal autograft in primary pterygium surgery.

Effect of experimental scleral shortening on axial length of the rabbit eye

PURPOSE

To evaluate the change of axial length (AL), intraocular pressure (IOP), and corneal astigmatism after scleral shortening with scleral invagination in the rabbit eye.

METHODS

The authors performed scleral shortening (3 mm) with scleral invagination in two groups of 6 eyes each: 180 degrees (group 1) and 360 degrees (group 2).

RESULTS

Average AL shortening was more prominent in group 2 (0.5 +/- 0.17 mm) than in group 1 (0.37 +/- 0.29 mm), but the difference was not statistically significant. IOP increased immediately after the procedure and was maintained at a high level through 2 months postoperatively. Induced corneal astigmatism was more prominent in group 1 than in group 2. The difference was statistically significant in group 1 (p<0.05) but not in group 2.

CONCLUSIONS

In the scleral shortening with scleral invagination procedure, a large amount of scleral invagination resulted in more shortening of axial length, but there was more corneal astigmatism in 180-degree invagination of the sclera than in 360-degree. Further research is required to determine the effect of the extent of scleral invagination on the change of these values.

Clinical Characteristics and Surgical Outcomes of Pseudophakic and Aphakic Retinal Detachments

We retrospectively evaluated the clinical characteristics and surgical outcomes of 20 pseudophakic retinal detachment (RD) patients (20 eyes) and 17 aphakic RD patients (17 eyes). Males were predominated in both groups. The time interval between cataract extraction and RD was 31 months on average in the pseudophakic group, 32 months with intact posterior capsule and 27 months with ruptured posterior capsule, and 148 months in the aphakic group. In 50% of cases with ruptured posterior capsule in the pseudophakic group, RD occurred within 1 year. The anatomic success rate was 95% in the pseudophakic group and 88% in the aphakic group. The most common cause of failure was the development of proliferative vitreoretinopathy. Visual acuities more than 20/40 after RD surgery were found in 13 pseudophakic (65%) and 6 aphakic (36%) eyes. Aphakic patients were more inclined to have silent RD than pseudophakic patients because of their poor visual acuity. Post-operative follow-up is required especially for the first 1 year in cases of damaged posterior capsule due to the high incidence of RD during this period.

The protection of the retina from ischemic injury by the free radical scavenger EGb 761 and zinc in the cat retina

We investigated the effects of a free radical scavenger (EGb 761) and zinc in experimentally induced ischemic injury in the cat retina. Total retinal ischemia for 90 min was produced in the left eyes of 40 cats by raising intraocular pressure. In group 1, 10 cats were used as control. The free radical scavenger (EGb 761, 100 mg/kg) in group 2 (10 cats) and zinc chloride (250 microg/kg) in group 3 (10 cats) were administered intravenously at the end of ischemia. In group 4, both EGb 761 (100 mg/kg) and zinc chloride (250 microg/kg) were injected into 10 cats. ERG and a histologic study were performed 1 h, 1 day, 3 days, 1 week and 2 weeks after ischemia. The amplitude of the ERG b-wave was 62.73+/-0.32, 84.31+/-6.10, 83.65+/-12.23 and 102.4+/-14.27%, and the summed amplitude of oscillatory potentials was 66.16+/-16.42, 99.44+/-14.92, 95.45+/-6.42 and 99.62+/-12.32% in each group 2 weeks after ischemia. There was no significant effect in animals that received zinc alone (group 3) by the end of 1 week but some additive effect in combining EGb 761 and zinc chloride (group 4) 1 h after ischemia. These findings suggest that the free radical scavenger EGb 761 may efficiently protect the retina from ischemic injury and zinc may have an additive effect when combined with a radical scavenger.

Aconite induced myelo-optic neuropathy in a rabbit model

Aconite is a common remedy of herb doctors and is widely used in the Far East. Clinical aspects of the visual disturbance produced by this drug have been described, but little is known about its pathology. Tinctura aconiti (0.6 mg of total alkaloid/kg 2x) was administered intraperitoneally in rabbits to evaluate its toxic effects on the visual system. The alteration in the visual evoked potential following aconite injection consisted of a delay in the onset and peak latency. Histopathologically, there were damages to the myelin sheath of the visual pathway, spinal cord and peripheral nerves. These findings suggest that aconite may cause primarily myelo-optic neuropathy.