Despite the fact that the choroid plays an important role in the structure and function of the eye, it has not been studied in detail in vivo. Improvements in optical coherence tomography (OCT) imaging technology allow the routine imaging of the choroid and deep optic nerve structures in most patients. As with any new technology, it needs validation in both healthy and diseased eyes. Reproducible mea-surements of choroidal and lamina cribrosa thickness are possible. Several variables such as age, axial length, and time of day, affect choroidal thickness and must be taken into account when interpreting data on choroidal thickness. Lamina cribrosa thickness appears to be affected by age as well but other factors need to be determined. Choroidal thickness may be used to differentiate between central serous chorioretinopathy (CSC), polypoidal choroidal vasculopathy (PCV) and exudative age-related macular degeneration (AMD). Enhanced depth imaging-optical coherence tomography (EDI-OCT) of the choroid may detect tumors not detectable by ultrasound. Studying the choroid may help us gain insight into the pathogenesis of several diseases such as AMD, CSC, glaucoma, posteriorly located choroidal tumors, and PCV among others.

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Sarcoidosis is a multisystem granulomatous inflammatory disease, and uveitis is the most common ocular manifestation. Herein we report a female sibling pair both having sarcoidosis with uveitis. A 59-year-old woman presented with chronic panuveitis in both eyes lasting for one year. Enlarged mediastinal lymph nodes were demonstrated on computed tomography, and mediastinoscopic biopsy revealed chronic non-caseating granulomatous inflammation. Sarcoidosis was diagnosed. Eight months later, her younger sister developed bilateral anterior and intermediate uveitis. She was also diagnosed with sarcoidosis confirmed by intrathoracic lymph node biopsy. This is the first report of familial sarcoidosis presented with uveitis in Taiwan.

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Background: The objective of our study was to compare the clinical outcomes of idiopathic full-thickness macular hole surgery using either triamcinolone (TA) or VisCoat treatment of the macular hole before indocyanine-green (ICG)-assisted internal-limiting-membrane (ILM) peeling. Methods: During macular hole surgery, the hole and adjacent areas were treated with TA (Group 1, n = 15 eyes) or VisCoat (Group 2, n = 22 eyes) to minimize ICG-induced toxicity during ILM peeling. Changes in visual acuity and anatomical success rates were compared between the two groups. Results: At 6 months following surgery, the hole closure rate was 80% (12/15 eyes) in Group 1 and 100% (22/22 eyes) in Group 2. The mean ± standard deviation logarithm of the minimum angle of resolution decreased from 1.40 ± 0.41 to 1.08 ± 0.38 in Group 1 (p = 0.04) and from 1.25 ± 0.41 to 0.75 ± 0.44 in Group 2 (p < 0.001), indicating that a greater increase in the average best corrected visual acuity had occurred in Group 2 than in Group 1 (p = 0.02). At 1 month following surgery, small outer-retinal blebs were noted in 42% of the closures in Group 1 and 9% of the closures in Group 2. The blebs persisted in four Group-1 participants for >1 year, but no long-standing outer retinal bleb occurred in Group 2. Conclusion: Participants who received the VisCoat treatment displayed a higher hole closure rate and a better final visual acuity than those who received the TA treatment. Participants who received the TA treatment also had more outer retinal blebs at 1 month and 1 year or more following the surgery.

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Purpose: To investigate the optical coherence tomographic (OCT) patterns and long-term surgical outcomes of patients with vitreomacular traction syndrome (VMT). Methods: From May 2002 to April 2008, patients with OCT-confirmed VMT who underwent vitrectomy were retrospectively reviewed. Complete pre- and postoperative ophthalmic and OCT examinations were recorded. All cases were followed for at least 2 years. The OCT patterns of VMT were classified into two groups: Group 1, V-shaped macular traction (1A: without macular detachment, 1B: with macular detachment); Group 2, U-shaped macular traction (2A: without macular detachment, 2B: with macular detachment). Multiple linear regression analysis of selective factors was performed to investigate the main determinants of visual improvement. Results: Twenty-five eyes of 25 consecutive patients were enrolled (8 in 1A, 6 in 1B, 6 in 2A, 5 in 2B). One patient in 2A progressed to 2B within 4 months. After surgery, 18 patients regained normal foveal contour accompanied by visual improvement; three patients had persistent cystoid macular edema throughout the follow-up period and a worsened visual acuity; the other four had an unchanged visual status despite improved foveal configuration. The mean ± standard deviation thickness in the central macular area was 632.0 ± 228.3 mm preoperatively and 347.1 ± 126.1 mm postoperatively (p < 0.001). Multiple lineal regression analysis revealed that U-shape VMT (p = 0.005), preoperative foveal detachment (p = 0.011) and preoperative visual acuity (p = 0.035) might correlate with final vision. Conclusion: OCT may detect two major configurations of VMT. Vitrectomy is an effective treatment, but U-shaped macular traction, preoperative foveal detachment and poor preoperative vision show unfavorable visual prognosis.

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Purpose: To quantify the 2-year success rate and complications of trabeculectomy with adjunctive mitomycin C (MMC). Methods: A retrospective chart review was undertaken of 147 eyes that had undergone trabeculectomy with adjunctive MMC (concentration from 0.1 to 0.27 mg/mL) and at least 2 years’ follow-up between January 2001 and March 2010. Demographic and clinical data were collected from all patients at the time of surgery and subsequent follow-up visits. Complete success was defined as intraocular pressure (IOP) ≤ 21 mmHg without any additional medication, whereas qualified success was defined as IOP ≤21 mmHg with or without medication. Results: At 24 months, mean IOP was 16.4 ± 10.6 mmHg, with a mean IOP decrease of 19.8 ± 14.2 mmHg. In primary glaucoma patients (n = 66), 60.6% and 95.4% of eyes achieved complete success and qualified success, respectively, at 2-year follow-up. Sub-group analysis of the initial trabeculectomy in primary glaucoma patients (n = 49) showed that complete and qualified success increased to 65.3% and 98.0%, respectively. The success rate was lower in secondary glaucoma patients (n = 74), with complete success at 41.9% and qualified success at 67.6% at 2-year follow-up. Eighty-six eyes (58.5%) developed one or more complications, from mild, such as hyphema, to severe, such as bleb leakage, which could necessitate surgical intervention. Twenty-six eyes developed severe complications, such as wound gap after 5 postoperative days, hypotony, hypotony maculopathy, choroidal detachment, overhanging bleb, bleb leakage, and endophthalmitis. A comparison between eyes with severe complications and other eyes in relation to different MMC amount, defined as MMC concentration multiplied by application duration, revealed no significant difference (p = 0.136). Further glaucoma surgery was performed in 27 eyes (18.4%). Conclusion: The outcome of trabeculectomy with low-dose intraoperative MMC is favorable in primary glaucoma patients at 2-year follow-up. Severe complications are not significantly related to MMC amount. Factors associated with severe complications require further study. Careful selection of MMC concentration and application time based on preoperative and intraoperative risk factors may further improve surgical results.

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Purpose: To evaluate the role of protein tyrosine phosphatase (PTP) in controlling the integrity of cell–cell junction and intercellular permeability in postconfluent bovine corneal epithelial cells. Methods: Confluent cultures of bovine corneal epithelial cells were treated with different concentrations of general phosphate inhibitors andsodium orthovanadate for varying periods. An MTS assay was used to confirm no cellular death under the treatment profile. Immunocytochemical (ICC) analysis was performed to demonstrate protein tyrosine phosphorylation after treatment with sodium orthovanadate, and the effect of sodium orthovanadate on junctional proteins such as p120, α-catenin, occludin, ZO-1, and ZO-2. Western blot analysis was used to analyze the changes in p120, α-catenin, occludin, ZO-1, and ZO-2 after treatment. Paracellular permeability was evaluated by transepithelial electrical resistance (TER). Results: During the whole course of treatment, no significant cellular death was noticed. Doseand timedependent effects of sodium orthovanadate on protein tyrosine phosphorylation were confirmed by ICC. ICC also demonstrated the dose- and time-dependent effect of sodium orthovanadate on the disruption of p120, α-catenin, occludin, ZO-1, and ZO-2. However, results of Western blot analysis showed no change in the expression levels of p120, α-catenin, occludin, ZO-1, and ZO-2. Dose- and time-dependent increase of paracellular permeability was evaluated by TER. Conclusion: Inhibition of protein tyrosine phosphatase activity can increase protein tyrosine phosphorylation. A dose- and time-dependent release of cell–cell contacts and increased transepithelial permeability were found in postconfluent culture of bovine corneal epithelial cells.

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A 47-year-old woman with gum cancer was diagnosed with acute endogenous endophthalmitis. Serratia marcescens was cultured from the vitreous and blood samples. A venous access port for chemotherapy was the only identifiable source of infection. After receiving systemic antibiotics therapy, the patient recovered from the bacteremia but lost her vision as a result of Serratia endophthalmitis.

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Purpose: To report the efficacy of oral clopidogrel for treatment of chronic and recurrent central serous chorioretinopathy (CSC). Methods: This is a retrospective uncontrolled case series. Fourteen eyes in 14 patients with the clinical and angiographic findings of chronic and recurrent CSC were enrolled. Clinical data including best- corrected visual acuity (BCVA), durations of symptoms, central retinal thickness (CRT) and macular volume measured on optical coherence tomography (OCT) were collected at baseline. Oral clopidogrel 75 mg daily was administrated at least for 2 weeks until the serous detachment resolved or no satisfactory result was obtained. OCT was performed monthly until the end of follow-up in all patients. Fluorescein angiography was repeated during the follow-up period in nine patients. Results: There were eight eyes with chronic CSC and six with recurrent CSC. After clopidogrel treatment for mean 8.07 weeks (range, 2–24 weeks), the BCVA improved or stabilized in 12 of 14 eyes (85.7%) at the end of follow-up. Nine eyes (64.3%) attained a complete resolution of serous detachment, and four (28.6%) had improvement in subretinal fluid reabsorption on OCT. The CRT and macular volume were significantly decreased compared with baseline (234.14 ± 62.46 μm vs. 355.64 ± 108.05 μm, and 7.145 ± 0.618 μL vs. 7.916 ± 1.056 μL, respectively, p < 0.001). Seven eyes (77.78%) showed decreased numbers of leaking point as well as decreased intensity of dye leakage on repeated fluorescein angiography and one eye (11.11%) had a complete resolution in previous dye leakage. Five eyes received additional treatments (four eyes with laser photocoagulation and one eye with photodynamic therapy) during or after the clopidogrel therapy. In the subgroup of patients without additional treatments, the difference of CRT and macular volume was still statistically significant. Conclusion: Clopidogrel seems to be effective in the treatment of chronic CSC in this study. Its antithrombotic and anti-inflammatory actions may improve the choroidal congestion and facilitate the reabsorption of subretinal fluid.

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