Purpose: To evaluate repeatability within and between examiners and to assess agreement in corneal thickness measurements obtained by anterior segment optical coherence tomography (ASOCT) and ultrasonic pachymetry (USP). Methods: This was a prospective, observational study. Fifty-one patients who visited a glaucoma service with suspected glaucoma, glaucoma, or cataract were enrolled. Patients with a history of corneal surgery or abnormalities and those who were uncooperative for examinations were excluded. Each patient underwent ASOCT followed by USP, with each test performed by two different examiners. Measurement repeatability was evaluated using intraclass correlation coefficient (ICC) values. Agreement in corneal thickness measurements was evaluated by the Bland and Altman plot method. Linear regression analysis was used to assess the relationship between ASOCT and USP measurements. Results: USP andASOCTcorneal thickness measurements revealed high intraexaminerand interexaminer repeatability (ICCs > 0.978). ASOCT corneal thickness measurements of a central 2-mm zone showed higher intraexaminer (ICC = 0.999) and interexaminer (ICC = 0.999) repeatability than USP measurements or ASOCT measurements of the vertex. The 95% limit of agreement (LoA) between the vertex-centered ASOCT and the USP scan was between 3.68 and 24.76 μ m. The 95% LoA between the central 2-mm zone ASOCT and the USP scan was between 3.75 and 23.39 μm. Average ASOCT corneal thickness was less than USP measurements, but ASOCT thickness could be converted to USP thickness through linear regression equations. Conclusion: Both devices have good intraexaminer and interexaminer repeatability, though ASOCT has slightly better interexaminer repeatability. ASOCT accurately and reliably measures corneal thickness in a noninvasive manner.

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Purpose: To evaluate foveal anatomical abnormalities after the successful repair of rhegmatogenous retinal detachments (RRDs) and to investigate the relationship between foveal microstructural changes and postoperative best-corrected visual acuity (BCVA). Materials and methods: This study was a retrospective consecutive case series comprising all RRD patients with anatomical reattachment performed bya single surgeon fromJanuary 2009 toJune 2010. Complete medical and ophthalmic histories, BCVA, duration of symptoms, number of breaks, extent of the retinal detachment (RD), lens status, and type of surgery were preoperatively recorded. The main outcome measurements for data analysis were postoperative BCVA and optical coherence tomography (OCT) imaging of the foveal microstructure. Results: Clinical data and OCT images were obtained from 83 eyes of 80 patients who underwent successful RRD surgeries. Anatomic foveal abnormalities were identified in 72% of eyes, including disruption of the junction between the inner and outer photoreceptor segments (IS/OS) in 59% of all cases with or without external limiting membrane (ELM) disruptions, residual subretinal fluid (7%), epiretinal membranes (22%), cystoid macular edema (7%), uneven surface (4%), retinal pigment epithelium (RPE) defects (1%), RPE folding (1%), and macular holes (2%). Multiple linear regression analysis showed that the significant factors associated with postoperative BCVA were ELM disruption and macular holes. Foveal photoreceptor layer integrity as determined by OCT imaging after a successful macula-off RD repair was used to classify each eye included in the study into one of three subgroups: intact IS/OSjunction and ELM (11), disrupted IS/OS junction but intact ELM (11), and disruption of the IS/OS junction and ELM (37). Mean postoperative BCVA (0.18 ± 0.13 logMAR units, 0.43 ± 0.26 logMAR units, and 0.69 ± 0.42 logMAR units, respectively) was significantly different among these subgroups (p < 0.001). Conclusion: OCT is a useful, noninvasive tool for evaluating foveal microstructural abnormalities and predicting visual outcomes after a successful RRD repair.

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A 14-year-old male had unilateral visual loss, blood-stained rhinorrhea, and generalized bruises with fever. Ocular echography of the right eye revealed unilateral hemorrhagic retinal detachment with internal echogenicity, and therefore, a hemorrhagic retinal detachment (oculus dexter). Peripheral blood smear tests revealed pancytopenia with 78% leukemic cells. Bone marrow sampling and genetic analysis established the diagnosis of acute promyelocytic leukemia. Hemorrhagic retinal detachment can be a presentation of acute promyelocytic leukemia, and thrombocytopenia and disseminated intravascular coagulation may be the etiologies. The combined bleeding diathesis is a challenging status for surgical management with poor visual prognosis.

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A 44-year-old female presented with bilateral eyelid swelling and painless, palpable mass over the lacrimal gland area for more than 1 year. A bilateral enlarged lacrimal gland with mild contrast enhancement was noted on computed tomography. Biopsy of the lacrimal gland showed lympho- plasmacytic infiltrate with focal hyaline and sclerotic change, and immunohistochemical staining revealed numerous IgG4-positive plasma cells, which was characteristic of IgG4 dacryoadentitis. Serum IgG and IgG4 levels were within normal range. The patient was treated with surgical excision instead of systemic steroid owing to poor tolerance. No tumor recurrence or systemic involvement was noted during the follow-up period. Our case highlights the importance of IgG4 dacryoadenitis in differentiating bilateral lacrimal gland inflammatory conditions. A normal serum IgG4 level does not rule out the diagnosis and surgical excision may be an alternative for those who are considered ineligible for corti- costeroid treatment.

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Background: Hypertension, dyslipidemia, and hyperglycemia are major risk factors for vascular reti- nopathy. The relationship between retinal thickness at the macular area and metabolic risk factors, as well as visual impairment, in elderly patients before developing vascular occlusion needs to be investigated. Methods: In this prospective, case-control study, patients >60 years old, without objective visual threatened ocular diseases or systemic abnormalities, except for hypertension, dyslipidemia or/and hy- perglycemia, were included for measurement of retinal thickness at the macular area by optical coherence tomography (OCT). Results: Fifty-four patients were analyzed; 11 patients had no metabolic risk factors, 16 had one, 17 had two, and 10 had three. There was no significant difference in age, and full and outer retinal thickness, but there was a significantly lower inner retinal thickness at the parafoveal (p = 0.0013) and perifoveal (p = 0.018) areas in patients with at least one metabolic risk factor. The superior (p = 0.040) and inferior (p = 0.046) inner retina at the perifovea and superior (p = 0.013) inner retinal thickness at the parafovea were sensitive to metabolic abnormalities. Only patients with three factors had significantly reduced best corrected visual acuity (BCVA). Keywords: inner retina macular thickness metabolic risk factors parafovea perifovea Conclusion: Elderly patients with metabolic risk factors had decreased inner retinal thickness at the para- and perifoveal areas before retinal vascular diseases. Accelerated inner retinal degeneration occurred prior to visual impairment.

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Purpose: The objective of this study is to evaluate the myopic shift in sulcus suture-fixated posterior chamber intraocular lenses (PC IOLs). Methods: It was a retrospective study of patients diagnosed with lens subluxation or aphakia who received sulcus suture-fixated PC IOLs from 2004 to 2010. Preoperative visual acuity; axial length; predicted IOL power by the SRK-T, Hoffer-Q, and Holladay-1 formulas; predicted refraction; postoperative visual acuity; and postoperative refraction were recorded. Differences between postoperative refraction and predicted refraction for an in-the-bag lens were calculated for each patient. Results: Twenty eyes from 16patients with sulcus suture-fixated PC IOLs were included inthe study. Another 18 eyes from 18 patientswithin-the-bag fixationofIOLwereassigned tothe controlgroup. Inastudygroup, the difference between postoperative spherical equivalent and predicted refraction was −1.66 ± 0.97 D. The simple linear regression suggests that the SRK-T formula provides a better calculation of IOL power than other formulas for sulcus suture fixation of PC IOL using our technique. A comparison of postoperative refraction shifts between the study and the control groups showed that the myopic shift was statistically significant in the study group (p < 0.001). Conclusion: Sulcus suture-fixation of a PC IOL induces, on average, a 1.66 D myopic shift, which is equivalent to an IOL power of around 2 D. In order to prevent a postoperative hyperopia refraction, we suggest that IOL power should be reduced to 1 –1.5 D for performing sulcus fixation using our technique.

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Purpose: To investigate the clinical outcomes of combined orbital radiotherapy and systemic glucocor-ticoids for patients with refractory Graves’ ophthalmopathy (GO). Materials and methods: The records were retrospectively reviewed of six patients with active moderate-to-severe GO who had been refractory to steroid therapy alone and treated with combined orbital radiotherapy and systemic glucocorticoids. All patients had already received one or more trial of steroid therapy prior to radiotherapy. Two patients had recurrence after steroid cessation, and four were unable to taper corticosteroids partially or completely. Two patients experienced relapse compressive optic neuropathy during tapering of glucocorticoids. The radiation dose was 20 Gy at 2 Gy/fraction. Presenting signs especially for disease activity and severity, treatment outcomes, and side effects were assessed. Results: After combined therapy, complete cessation of corticosteroid therapy and stabilization of disease without recurrence was achieved in all patients. The clinical activity score decreased from 6.0 to 2.5 (p = 0.04). The ophthalmopathy index decreased from 8.2 to 5.7 (p = 0.05), with significant improvement in soft tissue sign (p = 0.03) and extraocular muscle movement (p = 0.03). Both patients with relapse dysthyroid optic neuropathy regained their vision. Side effects of radiotherapy included posterior subcapsular cataract formation in one patient. Conclusion: Combined orbital radiotherapy and systemic corticosteroids can help to achieve stable disease and cessation of corticosteroid without recurrence in patients with refractory GO. This technique achieves greater improvement in clinical activity, soft tissue inflammation, and ocular motility.

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Infantile capillary hemangiomas (IHs) are common, benign, high flow, vascular tumors affecting children. These lesions typically involute spontaneously leaving no long-term sequelae and require no treatment. IHs can, however, be life and vision threatening depending on their extent and location. These lesions can be addressed with a number of treatment options including corticosteroids, surgical excision, and laser. Most recently, β-blockers have shown promising results when used both systemically and topically to treat IH. Beta-blockers are an exciting new treatment option for IH and have shown promising results with few reported side effects.

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Solitary fibrous tumor (SFT) is a rare spindle-cell neoplasm that can be found in the orbit. Here, we report two cases affected by orbital SFT. Both patients were female, aged 52 years and 59 years, respectively, and had experienced a painless unilateral orbital lesion. Computed tomography (CT) imaging revealed a well- circumscribed and contrast-enhanced soft tissue mass simultaneously. The tumors were located in the laterotemporal extraconal space of the right orbit and the inferior portion of the left orbit, respectively. Both patients underwent complete resection of their tumors. The histological findings showed alternating hypercellular and hypocellular areas composed of bland spindle cells with a fibrous stroma. The strong immunoreactivity for CD34 supported the diagnosis of orbital SFT. There was no recurrence at the 2-year and 3-year follow-up visits, respectively. SFTs should be considered in the differential diagnosis of an orbital tumor. The combination of a CT scan, histologic findings, and immunohistochemical staining will provide an accurate diagnosis. En bloc excision of the tumor is the mainstay of treatment in order to avoid recurrence.

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