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1.  Dacryoscintigraphic Findings in the Children with Tearing 
Purpose
To investigate the diagnostic effectiveness of dacryoscintigraphy in children with tearing; to evaluate tear clearance rate as a diagnostic factor of dacryoscintigraphy in children with tearing; and to analyze the results of treatment according to dacryoscintigraphic findings in children with tearing.
Methods
Between January 2010 and April 2014, 176 eyes of 88 children with tearing (49 boys and 39 girls; mean age, 23.81 ±14.67 months; range, 12 to 72 months) were studied retrospectively. Of these, 37 of 88 children with tearing were bilateral cases, and 51 were unilateral cases. None of the patients had a history of craniofacial disorder or trauma. The chief complaint of tearing with or without eye discharge and delivery mode, past history of neonatal conjunctivitis, syringing, or probing were collected from parents, grandparents, or previous hospital data. The drainage pattern of the nasolacrimal duct was analyzed, and the clearance rate of 50 µCi 99m technetium pertechnetate was measured by dacryoscintigraphy.
Results
According to the dacryoscintigraphy results, 98 of 125 eyes (78.4%) with tearing showed nasolacrimal obstruction and 29 of 51 eyes (56.9%) without tearing showed patency. There was a significant difference between tearing eyes and normal eyes (p = 0.001). The clearance rate difference after 3 and 30 minutes was 16.41 ± 15.37% in tearing eyes and 23.57 ±14.15% in normal eyes. There was a significant difference between epiphoric eyes and normal eyes (p = 0.05). Based on the dacryoscintigraphic findings, nasolacrimal-duct obstruction was treated with probing or silicone-tube intubation. The majority of patients showed symptom improvement (75.2%) during the two months of follow-up.
Conclusions
Dacryoscintigraphy is a non-invasive method of qualitatively and quantitatively diagnosing nasolacrimal duct obstruction in children with tearing.
doi:10.3341/kjo.2015.29.1.1
PMCID: PMC4309863  PMID: 25646054
Dacryoscintigraphy; Nasolacrimal duct; Obstruction; Tearing
2.  Transient Corneal Edema is a Predictive Factor for Pseudophakic Cystoid Macular Edema after Uncomplicated Cataract Surgery 
Purpose
To report transient corneal edema after phacoemulsification as a predictive factor for the development of pseudophakic cystoid macular edema (PCME).
Methods
A total of 150 eyes from 150 patients (59 men and 91 women; mean age, 68.0 ± 10.15 years) were analyzed using spectral domain optical coherence tomography 1 week and 5 weeks after routine phacoemulsification cataract surgery. Transient corneal edema detected 1 week after surgery was analyzed to reveal any significant relationship with the development of PCME 5 weeks after surgery.
Results
Transient corneal edema developed in 17 (11.3%) of 150 eyes 1 week after surgery. A history of diabetes mellitus was significantly associated with development of transient corneal edema (odds ratio [OR], 4.04; 95% confidence interval [CI], 1.41 to 11.54; p = 0.011). Both diabetes mellitus and transient corneal edema were significantly associated with PCME development 5 weeks after surgery (OR, 4.58; 95% CI, 1.56 to 13.43; p = 0.007; and OR, 6.71; CI, 2.05 to 21.95; p = 0.003, respectively). In the 8 eyes with both diabetes mellitus and transient corneal edema, 4 (50%) developed PCME 5 weeks after surgery.
Conclusions
Transient corneal edema detected 1 week after routine cataract surgery is a predictive factor for development of PCME. Close postoperative observation and intervention is recommended in patients with transient corneal edema.
doi:10.3341/kjo.2015.29.1.14
PMCID: PMC4309864  PMID: 25646056
Cataract; Corneal edema; Macular edema; Phacoemulsification; Risk factors
3.  Structural Analysis of Different Incision Sizes and Stromal Hydration in Cataract Surgery Using Anterior Segment Optical Coherence Tomography 
Purpose
To analyze healing changes of corneal wounds of different corneal incision sizes with or without stromal hydration in cataract surgery using anterior segment optical coherence tomography.
Methods
Cataract surgeries were performed by a single surgeon and 2.2- and 2.8-mm corneal incisions were made using a diamond blade (ME-759; Meyco, Biel-Bienne, Swiss). Patients were divided into four groups according to incision size (2.2 and 2.8 mm), and with/without stromal hydration. Fifteen eyes were assigned to each group and incision wounds were measured using anterior segment optical coherence tomography at 2 hours, 1 day, 1 week, 1 month, and 3 months postoperatively. Corneal thickness, incision length and incision angle were measured and existence of epithelial, endothelial gaping and Descemet's membrane detachment was evaluated.
Results
Incision thickness was greater in the group with stromal hydration than in the group without on operation day (p < 0.05). Stromal hydration exerted greater influence in the 2.2-mm incision group than in the 2.8-mm incision group. Corneal thickness decreased more rapidly in the stromal hydration group than in the group with no hydration (p = 0.022). Endothelial gaping was greater in the 2.2-mm incision group than in the 2.8-mm incision group 1 day, 1 month, and 3 months after surgery (p = 0.035, p = 0.009, and p = 0.008, respectively). No other statistical significance was observed between the two groups (2.2 and 2.8 mm) during follow-up regarding corneal thickness, epithelial gaping and Descemet's membrane detachment.
Conclusions
Corneal wounds with a smaller incision could be more vulnerable to external stimuli such as stromal hydration and are less stable than those with a larger incision.
doi:10.3341/kjo.2015.29.1.23
PMCID: PMC4309865  PMID: 25646057
Corneal pachymetry; Corneal stroma; Wounds and injuries
4.  Detecting the Progression of Normal Tension Glaucoma: A Comparison of Perimetry, Optic Coherence Tomography, and Heidelberg Retinal Tomography 
Purpose
We compared the abilities of Stratus optical coherence tomography (OCT), Heidelberg retinal tomography (HRT) and standard automated perimetry (SAP) to detect the progression of normal tension glaucoma (NTG) in patients whose eyes displayed localized retinal nerve fiber layer (RNFL) defect enlargements.
Methods
One hundred four NTG patients were selected who met the selection criteria: a localized RNFL defect visible on red-free fundus photography, a minimum of five years of follow-up, and a minimum of five reliable SAP, Stratus OCT and HRT tests. Tests which detected progression at any visit during the 5-year follow-up were identified, and patients were further classified according to the state of the glaucoma using the mean deviation (MD) of SAP. For each test, the overall rates of change were calculated for parameters that differed significantly between patients with and without NTG progression.
Results
Forty-seven (45%) out of 104 eyes displayed progression that could be detected by red-free fundus photography. Progression was detected in 27 (57%) eyes using SAP, 19 (40%) eyes using OCT, and 17 (36%) eyes using HRT. In early NTG, SAP detected progression in 44% of eyes, and this increased to 70% in advanced NTG. In contrast, OCT and HRT detected progression in 50 and 7% of eyes during early NTG, but only 30 and 0% of eyes in advanced NTG, respectively. Among several parameters, the rates of change that differed significantly between patients with and without progression were the MD of SAP (p = 0.013), and the inferior RNFL thickness (p = 0.041) and average RNFL thickness (p = 0.032) determined by OCT.
Conclusions
SAP had a higher detection rate of NTG progression than other tests, especially in patients with advanced glaucoma, when we defined progression as the enlargement of a localized RNFL defect. The rates of change of the MD of SAP, inferior RNFL thickness, and average RNFL thickness differed between NTG patients with and without progression.
doi:10.3341/kjo.2015.29.1.31
PMCID: PMC4309866  PMID: 25646058
Glaucoma progression; Heidelberg retinal tomography; Low tension glaucoma; Optical coherence tomography; Standard automated perimetry
5.  Comparison of Clinical Characteristics and Progression Rates of Bilaterally and Unilaterally Progressing Glaucoma 
Purpose
To compare the clinical characteristics of unilaterally progressing glaucoma (UPG) and simultaneously bilaterally progressing glaucoma (BPG) in medically treated cases.
Methods
Primary open angle glaucoma patients were classified as having UPG or BPG according to an assessment of optic disc and retinal nerve fiber layer photographs and visual field analysis. Risk factors including the presence of systemic diseases (hypertension, diabetes, cerebrovascular accident, migraine, and dyslipidema) were compared between the UPG and BPG groups. Baseline characteristics and pre- and post-treatment intraocular pressure (IOP) were compared between the progressing eye (PE) and the non-progressing eye (NPE) within the same patient in the UPG group and between the faster progressing eye and the slower progressing eye in the BPG group.
Results
Among 343 patients (average follow-up period of 4.2 years), 43 were categorized into the UPG group and 31 into the BPG group. The prevalence of all analyzed systemic diseases did not differ between the two groups. PEs in the UPG group had more severe pathology in terms of baseline visual field parameters than NPEs (mean deviation -6.9 ± 5.7 vs. -2.9 ± 3.9 dB, respectively; p < 0.001). However, baseline IOP, mean follow-up IOP, and other clinical characteristics were not significantly different between the PE and the NPE in the UPG group. The progression rate was significantly higher in the faster progressing eye in patients with BPG than in the PE for patients with UPG (-3.43 ± 3.27 vs. -0.70 ± 1.26 dB/yr, respectively; p = 0.014).
Conclusions
There were no significant differences in the prevalence of systemic diseases between the UPG and BPG groups. Simultaneously bilaterally progressing patients showed much faster progression rates than those with a unilaterally progressing eye.
doi:10.3341/kjo.2015.29.1.40
PMCID: PMC4309867  PMID: 25646059
Bilateral; Disease progression; Glaucoma; Unilateral; Visual fields
6.  Long-term Results from Cyclocryotherapy Applied to the 3O'clock and 9O'clock Positions in Blind Refractory Glaucoma Patients 
Purpose
To report the long-term follow-up results after cyclocryotherapy, applied to the 3-o'clock and 9-o'clock positions in blind refractory glaucoma patients.
Methods
We retrospectively reviewed the charts of 19 blind patients, and a total of 20 eyes with refractory glaucoma who were treated with cyclocryotherapy. Cyclocryotherapy treatments were performed using a retinal cryoprobe. The temperature of each cyclocryotherapy spot was -80℃ and each spot was maintained in place for 60 seconds. Six cyclocryotherapy spots were placed in each quadrant, including the 3-o'clock and 9-o'clock positions.
Results
The mean baseline pretreatment intraocular pressure (IOP) in all eyes was 50.9 ± 12.5 mmHg, which significantly decreased to a mean IOP at last follow-up of 14.1 ± 7.1 mmHg (p < 0.001). The mean number of antiglaucoma medications that patients were still taking at last follow-up was 0.3 ± 0.6. Devastating post-procedure phthisis occurred in only one eye.
Conclusions
Cyclocryotherapy, performed at each quadrant and at the 3-o'clock and 9-o'clock position, is an effective way to lower IOP and, thus, is a reasonable treatment option for refractory glaucoma patients who experience with ocular pain and headaches.
doi:10.3341/kjo.2015.29.1.47
PMCID: PMC4309868  PMID: 25646060
Cryotherapy; Refractory glaucoma
7.  Effect of Watching 3-Dimensional Television on Refractive Error in Children 
Purpose
To investigate the effect of watching 3-dimensional (3D) television (TV) on refractive error in children.
Methods
Sixty healthy volunteers, aged 6 to 12 years, without any ocular abnormalities other than refractive error were recruited for this study. They watched 3D TV for 50 minutes at a viewing distance of 2.8 meters. The image disparity of the 3D contents was from -1 to 1 degree. Refractive errors were measured both before and immediately after watching TV and were rechecked after a 10-minute rest period. The refractive errors before and after watching TV were compared. The amount of refractive change was also compared between myopes and controls. The refractive error of the participants who showed a myopic shift immediately after watching TV were compared across each time point to assure that the myopic shift persisted after a 10-minute rest.
Results
The mean age of the participants was 9.23 ± 1.75 years. The baseline manifest refractive error was -1.70 ± 1.79 (-5.50 to +1.25) diopters. The refractive errors immediately after watching and after a 10-minute rest were -1.75 ± 1.85 and -1.69 ± 1.80 diopters, respectively, which were not different from the baseline values. Myopic participants (34 participants), whose spherical equivalent was worse than -0.75 diopters, also did not show any significant refractive change after watching 3D TV. A myopic shift was observed in 31 participants with a mean score of 0.29 ± 0.23 diopters, which resolved after a 10-minute rest.
Conclusions
Watching properly made 3D content on a 3D TV for 50 minutes with a 10-minute intermission at more than 2.8 meters of viewing distance did not affect the refractive error of children.
doi:10.3341/kjo.2015.29.1.53
PMCID: PMC4309869  PMID: 25646061
Depth perception; Myopia; Refractive errors
8.  The Neuroprotective Effect of Maltol against Oxidative Stress on Rat Retinal Neuronal Cells 
Purpose
Maltol (3-hydroxy-2-methyl-4-pyrone), formed by the thermal degradation of starch, is found in coffee, caramelized foods, and Korean ginseng root. This study investigated whether maltol could rescue neuroretinal cells from oxidative injury in vitro.
Methods
R28 cells, which are rat embryonic precursor neuroretinal cells, were exposed to hydrogen peroxide (H2O2, 0.0 to 1.5 mM) as an oxidative stress with or without maltol (0.0 to 1.0 mM). Cell viability was monitored with the lactate dehydrogenase assay and apoptosis was examined by the terminal deoxynucleotide transferase-mediated terminal uridine deoxynucleotidyl transferase nick end-labeling (TUNEL) method. To investigate the neuroprotective mechanism of maltol, the expression and phosphorylation of nuclear factor-kappa B (NF-κB), extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK), and p38 were evaluated by Western immunoblot analysis.
Results
R28 cells exposed to H2O2 were found to have decreased viability in a dose- and time-dependent manner. However, H2O2-induced cytotoxicity was decreased with the addition of maltol. When R28 cells were exposed to 1.0 mM H2O2 for 24 hours, the cytotoxicity was 60.69 ± 5.71%. However, the cytotoxicity was reduced in the presence of 1.0 mM maltol. This H2O2-induced cytotoxicity caused apoptosis of R28 cells, characterized by DNA fragmentation. Apoptosis of oxidatively-stressed R28 cells with 1.0 mM H2O2 was decreased with 1.0 mM maltol, as determined by the TUNEL method. Western blot analysis showed that treatment with maltol reduced phosphorylation of NF-κB, ERK, and JNK, but not p38. The neuroprotective effects of maltol seemed to be related to attenuated expression of NF-κB, ERK, and JNK.
Conclusions
Maltol not only increased cell viability but also attenuated DNA fragmentation. The results obtained here show that maltol has neuroprotective effects against hypoxia-induced neuroretinal cell damage in R28 cells, and its effects may act through the NF-κB and mitogen-activated protein kinase signaling pathways.
doi:10.3341/kjo.2015.29.1.58
PMCID: PMC4309870  PMID: 25646062
Maltol; Neuroprotection; Oxidative stress; Rat retinal neuronal cell
11.  Risk Factors for Fluoroquinolone Resistance in Ocular Cultures 
Purpose
To identify the risk factors associated with fluoroquinolone resistance in patients undergoing cataract surgery.
Methods
A total of 1,125 patients (1,125 eyes) who underwent cataract surgery at Veterans Health Service Medical Center from May 2011 to July 2012 were enrolled in this study. Conjunctival cultures were obtained from the patients on the day of surgery before instillation of any ophthalmic solutions. The medical records of patients with positive coagulase negative staphylococcus (CNS) and Staphylococcus aureus (S. aureus) cultures were reviewed to determine factors associated with fluoroquinolone resistance.
Results
Of 734 CNS and S. aureus cultures, 175 (23.8%) were resistant to ciprofloxacin, levofloxacin, gatifloxacin, or moxifloxacin. Use of fluoroquinolone within 3 months and within 1 year before surgery, topical antibiotic use other than fluoroquinolone, systemic antibiotic use, recent hospitalization, ocular surgery, intravitreal injection and use of eyedrops containing benzalkonium chloride were significantly more frequent in resistant isolates than in susceptible isolates. In multivariable logistic regression analysis, ocular surgery (odds ratio [OR], 8.457), recent hospitalization (OR, 6.646) and use of fluoroquinolone within 3 months before surgery (OR, 4.918) were significant predictors of fluoroquinolone resistance, along with intravitreal injection (OR, 2.976), systemic antibiotic use (OR, 2.665), use of eyedrops containing benzalkonium chloride (OR, 2.323), use of fluoroquinolone within 1 year before surgery (OR, 1.943) and topical antibiotic use other than fluoroquinolone (OR, 1.673).
Conclusions
Recent topical fluoroquinolone use, hospitalization and ocular surgery were significantly associated with fluoroquinolone resistance in CNS and S. aureus isolates from ocular culture.
doi:10.3341/kjo.2015.29.1.7
PMCID: PMC4309873  PMID: 25646055
Benzalkonium compounds; Cataract extraction; Fluoroquinolones; Staphylococcus; Staphylococcus aureus
16.  Levator Resection in the Management of Myopathic Ptosis 
Purpose
To evaluate the results of levator resection in patients with myopathic ptosis.
Methods
The medical records of consecutive patients who underwent levator resection surgery performed for myopathic ptosis between October 2009 and March 2013 were reviewed. Indications for surgery were ptosis obscuring the visual axis and margin-reflex distance ≤2 mm. Surgical success was defined as clear pupillary axis when the patient voluntarily opened his eye and margin-reflex distance ≥3 mm. We analyzed the effect of levator function and Bell's phenomenon on the rates of success and corneal complication.
Results
This series included six male and six female patients. Levator function was between 4 and 12 mm. We performed bilateral levator resection surgery in all patients. The mean follow-up time was 14.8 months (range, 6 to 36 months). No patient was overcorrected. Adequate lid elevation was achieved after the operation in 20 eyes. Ptosis recurred in three out of 20 eyes after adequate lid elevation was achieved. Our overall success rate was 70.8%. In three eyes with poor Bell's phenomenon, corneal irritation and punctate epitheliopathy that required artificial eye drops and ointments developed in the early postoperative period, although symptoms resolved completely within 2 months of the resection surgery. No patients required levator recession or any other revision surgery for lagophthalmos or corneal exposure after levator resection.
Conclusions
Levator resection seems to be a safe and effective procedure in myopathic patients with moderate or good Bell's phenomenon and levator function greater than 5 mm.
doi:10.3341/kjo.2014.28.6.431
PMCID: PMC4239460  PMID: 25435744
Blepharoptosis; Levator resection
17.  Prevalence and Spatial Concordance of Visual Field Deterioration in Fellow Eyes of Glaucoma Patients 
Purpose
To examine the prevalence of visual field deterioration in contralateral eyes of patients with worsening open-angle glaucoma and to evaluate the spatial concordance of visual field deterioration between both eyes.
Methods
One hundred sixteen open-angle glaucoma patients who underwent 8 or more visual field examinations over ≥6 years of follow-up were included. The rates of the fast and slow components of visual field decay for each of 52 visual field test locations were calculated with point-wise exponential regression analysis. The spatial concordance of visual field deterioration in contralateral eyes was evaluated with a concordance ratio (calculated as the number of overlapping locations divided by the total number of deteriorating locations) and by comparing the rate of decay in corresponding modified glaucoma hemifield test clusters.
Results
The average visual field mean deviation (±standard deviation [SD]) was -8.5 (±6.4) dB and the mean (±SD) follow-up time was 9.0 (±1.6) years. Sixty-three patients had mild damage, 23 had moderate damage, and 30 had severe damage. The mean concordance ratio (±SD) was 0.46 (±0.32) for the mild group, 0.33 (±0.27) for the moderate group, and 0.35 (±0.21) for the severe group. Thirty-one patients (27%) had deterioration in concordant locations (p < 0.05). Visual field deterioration was greater in the superior hemifield than the inferior hemifield (p < 0.05) when evaluated with both the concordance ratio and modified glaucoma hemifield test cluster analysis methods.
Conclusions
There is only fair spatial concordance with regard to visual field deterioration between the both eyes of an individual. We conclude that testing algorithms taking advantage of inter-eye spatial concordance would not be particularly advantageous in the early detection of glaucomatous deterioration.
doi:10.3341/kjo.2014.28.6.436
PMCID: PMC4239461  PMID: 25435745
Point-wise exponential regression analysis; Spatial concordance; Visual field deterioration
18.  Accuracy of Biometry for Intraocular Lens Implantation Using the New Partial Coherence Interferometer, AL-scan 
Purpose
To compare the refractive results of cataract surgery measured by applanation ultrasound and the new partial coherence interferometer, AL-scan.
Methods
Medical records of 76 patients and 104 eyes who underwent cataract surgery from January 2013 to June 2013 were retrospectively reviewed. Biometries were measured using ultrasound and AL-scan and intraocular lens power was calculated using the SRK-T formula. Automatic refraction examination was done 1 month after the operation, and differences between the ultrasound group and AL-scan group were compared and analyzed by mean absolute error.
Results
Mean axial length measured preoperatively by the ultrasound method was 23.53 ± 1.17 mm while the lengths measured using the AL-scan were 0.03 mm longer than that of the ultrasound group (23.56 ± 1.15 mm). However, there was not a significant difference in this finding (p = 0.638). Mean absolute error was 0.34 ± 0.27 diopters in the ultrasound group and 0.36 ± 0.31 diopters in AL-scan group, which showed no significant difference (p = 0.946) in precision of predicting postoperative refraction.
Conclusions
Although the difference was not statistically significant, intraocular lens calculations done by the AL-scan were nearly similar in predicting postoperative refraction compared to those of applanation ultrasound, however more precise measurements may be obtained if the axial length is longer than 24.4 mm. Except in the case of opacity in the media, which makes obtaining measurements with the AL-scan difficult, AL-scan could be a useful biometry in cataract surgery.
doi:10.3341/kjo.2014.28.6.444
PMCID: PMC4239462  PMID: 25435746
Biometry; Interferometery; Phacoemulsification; Ultrasonography
19.  Changing Trends in Surgery for Retinal Detachment in Korea 
Purpose
To analyze trends in rhegmatogenous retinal detachment (RRD) surgery among the members of the Korean Retina Society from 2001 to 2013.
Methods
In 2013, surveys were conducted by email and post to investigate the current practice patterns regarding RRD treatment. Questions included how surgeons would manage six cases of hypothetical RRD. Results were compared to those reported in 2001.
Results
A total of 133 members (60.7%) in 2013 and 46 members(79.3%) in 2001 responded to the survey. Preference for pneumatic retinopexy has decreased in uncomplicated primary RRD (p = 0.004). More respondents in 2013 selected vitrectomy as the primary procedure when mild vitreous hemorrhage (p = 0.001), myopia (p = 0.044) and history of successful scleral buckling on the fellow eye (p = 0.044) were added to the primary scenario. Vitrectomy was over twice as popular in cases of pseudophakic, macula-off RRD with posterior capsular opacity (p = 0.001).
Conclusions
For RRD with myopia, pseudophakia and media opacity, surgical interventions over the last decade have drastically shifted from scleral buckling and pneumatic retinopexy to vitrectomy.
doi:10.3341/kjo.2014.28.6.451
PMCID: PMC4239463  PMID: 25435747
Rhegmatogenous retinal detachment; Pneumatic retinopexy; Scleral buckling; Surgery; Vitrectomy
20.  Elevated Plasma Pentraxin 3 and Its Association with Retinal Vein Occlusion 
Purpose
To evaluate plasma pentraxin 3 (PTX3) in patients with retinal vein occlusion (RVO), and investigate the possibility of its role as a predictive biomarker.
Methods
Nested case-control study. The study included 57 patients with RVO and 45 age- and gender-matched subjects without RVO as controls. Plasma PTX3 and C-reactive protein concentration were measured in both groups a posteriori from frozen samples by using an enzyme-linked immunosorbent assay kit.
Results
The measured PTX3 value for the RVO group was 1,508 ± 1,183 pg/mL (mean ± standard deviation) and 833 ± 422 pg/mL for the controls (p < 0.001). There was no significant difference in PTX3 levels between patients with central retinal vein occlusion and branched retinal vein occlusion (1,468 ± 1,300 vs. 1,533 ± 1,121 pg/mL; p = 0.818).
Conclusions
Our data seems to support the role of chronic inflammation and ischemia in the development of RVO. It is possible that PTX3 can be used as a diagnostic biomarker of RVO.
doi:10.3341/kjo.2014.28.6.460
PMCID: PMC4239464  PMID: 25435748
Biological markers; Inflammation; Ischemia; Pentraxin3; Retinal vein occlusion
21.  Intravitreal Anti-vascular Endothelial Growth Factor for Typical Exudative Age-related Macular Degeneration in Eyes with Good Baseline Visual Acuity 
Purpose
To investigate 12-month treatment outcomes of anti-vascular endothelial growth factor therapy in eyes with typical exudative age-related macular degeneration with good baseline visual acuity.
Methods
This retrospective observational case series included 18 eyes (18 patients) with typical exudative age-related macular degeneration with a baseline best-corrected visual acuity of 20 / 25 or better. Patients were treated with anti-vascular endothelial growth factor monotherapy during the 12-month follow-up period. Baseline visual acuity and central foveal thickness were compared to the values at 12 months.
Results
Patients received an average of 4.4 ± 1.3 intravitreal anti-vascular endothelial growth factor injections. The mean logarithm of minimum angle of resolution visual acuity was 0.08 ± 0.04, 0.08 ± 0.07, 0.12 ± 0.09, and 0.16 ± 0.11 at baseline, three months, six months, and 12 months, respectively. Visual acuity at 12 months was significantly worse than the baseline value at diagnosis (p = 0.017), and the mean central foveal thickness at the defined time points was 270.2 ± 55.6, 204.4 ± 25.4, 230.1 ± 56.3, and 216.8 ± 48.7 µm, respectively. The central foveal thickness at 12 months was significantly less than the baseline value at diagnosis (p = 0.042).
Conclusions
Deterioration in visual acuity was noted in eyes with typical exudative age-related macular degeneration with good baseline visual acuity, suggesting the need for close patient monitoring and prompt treatment even in patients with good baseline visual acuity.
doi:10.3341/kjo.2014.28.6.466
PMCID: PMC4239465  PMID: 25435749
Anti-vascular endothelial growth factor; Bevacizumab; Good visual acuity; Macular degeneration; Ranibizumab
22.  Comparison of the Thickness of the Lamina Cribrosa and Vascular Factors in Early Normal-tension Glaucoma with Low and High Intraocular Pressures 
Purpose
To compare the thickness of the lamina cribrosa (LC) and vascular factors of early normal-tension glaucoma (NTG) patients with high and low intraocular pressure (IOP) that are expected to be associated with the development of glaucoma.
Methods
Seventy-one Korean NTG patients with low IOP (the highest IOP <15 mmHg, 40 patients) and high IOP (the lowest IOP >15 mmHg, 31 patients) were included in this study. The thickness of LC and vascular factors were compared. The thickness of the LC was measured using the enhanced depth imaging method with spectral domain optical coherence tomography (Heidelberg Spectralis).
Results
The mean thickness of the central LC was 190.0 ± 19.2 µm in the low IOP group and 197.8 ± 23.6 µm in the high IOP group, but there was no statistical significant difference between the two groups (p > 0.05). The prevalence of self-reported Raynaud phenomenon was significantly higher in the low IOP group (33.0%) than the high IOP group (10.3%, p = 0.04).
Conclusions
The laminar thickness did not significantly differ between the high and low IOP groups. However, the prevalence of Raynaud phenomenon was higher in the low IOP groups. These results suggest that the development of glaucoma with low IOP patients may be more influenced by peripheral vasospasm, such as Raynaud phenomenon, rather than laminar thickness in NTG.
doi:10.3341/kjo.2014.28.6.473
PMCID: PMC4239466  PMID: 25435750
Enhanced depth imaging method; Lamina cribrosa; Low tension glaucoma; Spectral domain optical coherence tomography
23.  Congenital Aniridia: Long-term Clinical Course, Visual Outcome, and Prognostic Factors 
Purpose
To describe the clinical course of congenital aniridia and to evaluate prognostic factors for visual outcome after long-term follow-up.
Methods
The medical records of 120 eyes from 60 patients with congenital aniridia were retrospectively reviewed. The prevalence and clinical course of ophthalmic characteristics, systemic disease, refractive errors, and visual acuity were assessed. Prognostic factors for final visual outcomes were analyzed.
Results
Aniridic keratopathy developed in 82 (69%) of 119 eyes. Macular hypoplasia was observed in 70 eyes of 35 patients (91%). Cataract was observed in 63 of 120 eyes (53%). Nystagmus was present in 41 patients (68% of 60 patients) at the initial visit but decreased in five patients (8% of 60 patients). Ocular hypertension was detected in 19 eyes (20% of 93 eyes), six (32% of 19 eyes) of which developed secondarily after cataract surgery. The mean changes in spherical equivalent and astigmatism during the follow-up period were -1.10 and 1.53 diopter, respectively. The mean final visual acuity was 1.028 logarithm of minimal angle of resolution. Nystagmus and ocular hypertension were identified as prognostic factors for poor visual outcome.
Conclusions
Identification of nystagmus and ocular hypertension was important to predict final visual outcome. Based on the high rate of secondary ocular hypertension after cataract surgery, careful management is needed.
doi:10.3341/kjo.2014.28.6.479
PMCID: PMC4239467  PMID: 25435751
Aniridia; Eye abnormalities; Prognosis
24.  Introduction of Lens-angle Reconstruction Surgery in Rabbit Eyes 
Purpose
In this study, we examined the stability of the lens-angle supporter (LAS) for accommodation restoration by comparing intraocular lens (IOL) location, after-cataract and ciliary body damage after cataract surgery in rabbits.
Methods
Eight rabbits were divided into experimental and control groups of four rabbits each. Phacoemulsification and irrigation and aspiration were performed in all rabbits. This was followed by an LAS and IOL insertion in the four experimental rabbits. In the four control rabbits, only an IOL insertion was performed. Six months after the surgery, the location of the IOL, the conditions of the lens capsule and ciliary body were evaluated using a slitl-amp examination and Miyake-Apple view.
Results
For the experimental group, the ultrasound biomicroscope results showed normal LAS and IOL positioning in all four cases. According to the slitlamp examination and Miyake-Apple view, the IOL was positioned at the center, with less after-cataract and damage to the ciliary body. For the control group, ultrasound biomicroscope results indicated a higher IOL position than normal, as well as a single case of IOL decentering. According to the slit-lamp examination and Miyake-Apple view, the IOL was decentered with more severe after-cataract and ciliary body damage.
Conclusions
The LAS has the potential to maintain a stable IOL position while producing less after-cataract when used in lens-angle reconstruction for correction of presbyopia. Moreover, LAS implantation incurs less damage to the ciliary body.
doi:10.3341/kjo.2014.28.6.486
PMCID: PMC4239468  PMID: 25435752
Accommodation; Cataract surgery; Presbyopia

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