Anterior segment optical coherence tomography has the ability to acquire angle-to-angle cross-sectional anterior chamber images in a non-contact way, and this technology shows a good reproducibility for angle parameters. With the availability of image processing software, some novel anatomic parameters such as iris area, iris volume, anterior chamber area, anterior chamber volume, anterior chamber width, and lens vault have been evaluated for the diagnosis of angle-closure related disease. This review article will describe the definitions of these interior segment optical coherence tomography parameters and summarize recent findings about these parameters in diagnosing angle-closure disease.

Complex retinal detachment includes proliferative vitreoretinopathy, traction retinal detachment, giant retinal breaks, and a subset of retinal detachments associated with trauma. These situations present a particular challenge to retinal reattachment procedures. Specific intraoperative and postoperative vitreoretinal techniques may facilitate effective repair of complex cases. The author present a review of vitrectomy techniques, microsurgical instrumentation, and postoperative management with intravitreal tamponade agents. Many techniques and tools are required to repair complex retinal detachments; a vitreoretinal surgeon must master all the described techniques and utilize flexible decision-making. A 25-gauge, sutureless vitrectomy without scleral buckling is the best option for complex retinal detachments.

Purpose: The objective of this study is to assess the safety and efficacy of switching to brinzolamide 1% and timolol 0.5% fixed combination (BTFC) from prior pharmacotherapy in patients with open-angle glaucoma (OAG) or ocular hypertension (OH) in Taiwan. Methods: This was a multicenter, open-labeled, interventional prospective study. The 8-week study involved patients with OAG or OH with uncontrolled intraocular pressure (IOP) and consisted of three study visits to the clinical site. Patients were instructed to discontinue their prior medications at the first visit, prior to starting the study medication. Enrolled patients were dosed with BTFC twice daily in both eyes for 8 weeks. IOP measurements and safety evaluations were conducted at both Week 4 and Week 8. Results: A total of 74 patients were enrolled. The overall mean IOP reductions from baseline after Week 8 of BTFC was 3.45 mmHg (15.42%); when subgrouped by prior medication class (β-blockers vs. non-β-blockers), the reduction in mean IOP after transitioning to BTFC at Week 8 was as follows: subgroup β-blockers were 3.23 mmHg (14.9 %) and non-β-blockers were 3.58 mmHg (15.25%). All mean IOP changes from baseline were statistically significant (p < 0.001). of the 69 patients (per protocol population) who were switched to BTFC regardless of prior therapy, 37 (53.6%) patients at Week 4 and 38 (55.1%) patients at Week 8 had IOP ≤ 18 mmHg. No treatment-related serious adverse events were reported in this study. Conclusion: The results of this study demonstrated the potential benefit of using BTFC as a replacement therapy in order to ensure adequate IOP control. BTFC administered twice daily was safe and effective in patients with uncontrolled IOP in Taiwan.

Purpose: The objective of this study was to evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) implantation in Taiwanese patients with intractable glaucoma. Methods: The study was a retrospective interventional case series conducted at a single institution between January 2004 and January 2008 in Taiwan. The study population included 148 patients (148 eyes). Results: The mean preoperative intraocular pressure (IOP) was 32.6 ± 4.7 mmHg with medication (mean number of medications was 3.4 ± 1.0; range, 2–4). Postoperatively, the mean IOP declined significantly to 10.2 mmHg (range, 7–18 mmHg) on Day 1 (p < 0.01) and 17 mmHg (range, 15–23 mmHg) at the last follow-up examination (p < 0.01). Ninety-four patients (63.5%) exhibited hypertensive phase (HP); among them 73 patients (49.3%) experienced HP at 1 month and 21 (14.2%) at 2 months after the operation. The cumulative probability of success according to Kaplan–Meier life-table analysis was 78% at 12 months and 43% at 3 years. There were no serious complications involving loss of visual acuity or sight. Conclusion: AGV implantation is an acceptable treatment for intractable glaucoma in high-risk Taiwanese patients with few additional options.

Purpose: To report the prevalence of vitreomacular interface abnormality (VMIA) and the incidence of the development of VMIA in patients with diabetic macular edema (DME). Factors associated with the development of VMIA were also investigated. Methods: This is a retrospective observational study. Patients with DME who were followed for at least 6 months were reviewed. Ophthalmoscopic examination, fundus photography, fluorescein angiography, and optical coherence tomography were used to detect DME and VMIA. Results: A total of 244 eyes in 180 patients were found to have DME at the initial visit, of these, 16 eyes (6.56%) were also diagnosed with VMIA. Ninety-six eyes in 76 patients with DME who did not receive an intravitreal operation or medications were included in the follow-up study. VMIA developed in 8 eyes (8.33%) over a mean follow-up duration of 22.63 months, which corresponded to a calculated annual incidence of 4.42%. The mean time from the initial visit to the detection of VMIA was 19 months, older age was found to be a risk factor for the development of VMIA. The occurrence of VMIA was associated with worsening visual acuity and a thicker central retinal thickness on the final visit. Conclusion: This study reveals the prevalence of VMIA on the initial visit and the incidence and risk factors associated with the occurrence of VMIA in patients with DME. This study also found that the occurrence of VMIA was significantly associated with poor visual outcomes and worsened macular edema at the end of the observation period.

Background/Purpose: In patients with early-onset homonymous hemianopia, ipsilateral exotropia and face turn could be a functional adaptation/compensation to expand the visual field. This case series study analyzed early-onset exotropia with homonymous hemianopia. Methods: Medical records of eight consecutive patients with early-onset exotropia and homonymous hemianopia were reviewed. Results: The five females and three males in this study (age range, 6–48 years) were followed up for an average of 28.3 months. In all patients, the fixating eye was contralateral to the side of the (major) visual field defect except in one patient (case 6) with maculopathy in the contralateral eye. of the four patients who received strabismus surgery, one had troublesome diplopia after the surgery while the other three were free of complications. Conclusions: Some patients with homonymous hemianopia and exotropia, particularly young and/or female patients, may conclude that the cosmetic and psychosocial gains achieved by strabismus surgery outweigh the potential surgical complications such as decreased visual field or diplopia. However, these patients require consultation and thorough education in the potential outcomes of the procedure.

A 61-year-old man presented to our hospital with right eye pain and headache off and on for 1 month. He had twice trabeculectomy in the right eye 25 years ago without using antiglaucoma agents. Snellen visual acuity (VA) was 20/400 and intraocular pressure (IOP) was 52 mm Hg in his right eye. The slit-lamp examination of his right eye revealed corneal microcystic edema and two blebs were noted. The nasal upper bleb had thinner wall with obvious focal underlying uvea dark color and temporal upper bleb had relative thicker wall. Both blebs showed low lying and high vascularity. No pupillary block was present. Considering the risks of repeat trabeculectomy and drainage implant, needle revision was done on the temporal upper bleb. A mixture of lidocaine and mitomycin c (MMC) was prepared for a final MMC concentration of 0.07 mg/ml. After 15 minutes of subconjunctival injection of lidocaine-MMC mixture, the needle revision was done to disrupt any episcleral and scleral fibrosis. Restoration of aqueous drainage was considered to be the end point when the bleb height was restored. The right eye VA was 20/100 on postoperatively Day 1 and IOP was 8 mm Hg. The only minor complication was subconjunctival hemorrhage. The IOP was around 10–15 mm Hg without antiglaucoma agent during a 6-month follow-up. The temporal upper bleb remained moderate height without hypervascularity or cystic change and no corneal edema was noted. Bleb needling with adjunctive MMC is simple and safe. It should be considered in the management of failing or failed filtration blebs.

A 28-year-old Chinese man presented with refractory ocular redness in the bilateral eyes. His symptoms co-existed with dysphasia and acute body weight loss. Excisional biopsy of the conjunctiva and hilar lymph nodes was performed and Löfgren’s syndrome was confirmed. The patient was treated with systemic steroid and symptoms gradually subsided over the 2-year follow-up period. Ocular redness and dysphagia with acute body weight loss are atypical symptoms of Löfgren’s syndrome. Careful survey and prompt treatment is necessary.

An 8-year-old boy presented with blurred vision in both eyes with intermittent pain over his brow area for 1–2 weeks. There was an episode of upper respiratory tract infection shortly after he had received H1N1 vaccination 1 month previously. Decreased visual acuity (especially in the right eye) with impaired color vision in both eyes was also noted. Results of his physical examination were all within normal limits except for a bilateral swollen disc. Brain magnetic resonance imaging revealed multiple hyperintense patches in the subcortical white matter of the bilateral frontal–parietal lobes. Methylprednisolone pulse therapy was prescribed then tapered with oral prednisolone for 6 months. Following magnetic resonance imaging performed 6 months after initial treatment, the previous lesions were no longer seen. A diagnosis of acute disseminated encephalomyelitis was confirmed. Visual acuity was recovered in the latest follow-up. Isolated optic neuritis is an uncommon feature of acute disseminated encephalomyelitis. It should be differentiated from multiple sclerosis, which will relapse, and permanent hyperintense lesions can be seen in the follow-up images.