This study aims to report our experience of using fluid-ventilated, gas-permeable scleral contact lenses (SCLs) for visual rehabilitation of patients with keratoconus and irregular astigmatism after refractive surgery. This is a noncomparative interventional case series reporting eight consecutive patients fitted with SCLs because of irregular astigmatism following the failure of other optical corrections. Retrospective chart review and data analysis included age, sex, etiology prior to lens fitting, visual outcomes, follow-up time, and complications. Twelve eyes of eight patients were studied. All eyes were fitted with SCLs due to unsatisfactory vision with spectacle correction or other contact lens modalities. Five eyes had keratoconus and seven had irregular corneas post refractive surgery. The mean follow-up period was 14.4 ± 1.3 months (range 11–17 months). The mean age was 32.63 ± 7.68 years (range 18–48 years). The average steepest keratometry(Kmax) of our series was 49.56 ± 12.2 D. The mean refractive astigmatism was 5.50 ± 5.3 D. The mean best corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution improved from 0.71 ± 0.50 (range 0.10–1.40) to 0.05 ± 0.07 (range 0.00–0.15) after SCL fitting (p < 0.001). All reported eyes achieved significant improvement in the BCVA with SCL fitting. None of the patients discontinued to wear SCLs. SCLs should be considered lenses of choice in irregular corneas refractory to conventional optical correction.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Purpose: The utility of digital fundus images in retinopathy of prematurity (ROP) screening has been established. A smartphone can be a device available to most ophthalmologists to capture digital fundus photographs. In this study, fundus images were captured with original camera settings for ROP documentation. Methods: The examination was performed under topical anesthesia. An assistant held a glass stick against the eye movement if infants moved their eyes too frequently. A hand-held smartphone and a 30D lens were used to record the fundus in video mode. A continuous flash was turned on to provide almost constant coaxial illumination. Fundus photographs were captured from the video film. Results: Fundus photographs can be captured successfully with a smartphone and a 30D lens under original camera settings. Conclusion: Fundus photographs of acceptable diagnostic quality can be obtained in ROP patients conveniently and inexpensively using a portable hand-held smartphone. It might be a useful tool in documentation, education, consultation, and telemedicine in ROP.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

This article discusses the diagnosis and management of abnormal vitreomacular interfaces disorders including vitreomacular adhesion, vitreomacular traction, epiretinal membrane, full thickness macular holes, lamellar holes and pseudoholes. Optical coherence tomography has better enabled our ability to diagnose abnormalities of the vitreoretinal interface by providing clinical information that cannot be obtained by other ophthalmic diagnostic techniques. While vitrectomy remains the most commonly performed treatment for these disorders, the recent introduction of pharmacologic vitreolysis represents the development of non-surgical treatment options of certain diseases of the vitreoretinal interface.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

We herein report the current status of ophthalmology in Taiwan. There are 1667 ophthalmologists in Taiwan (up to the year 2011), with an average of 7.22 eye specialists/100,000 people. The ophthalmology residency program is a 4-year course in Taiwan, and around 40–44 new residents pass out each year. The Ophthalmological Society of Taiwan and many other professional ophthalmological organizations, and 30 teaching hospitals provide continuing education for practicing ophthalmologists and hospital staff. From 2002 to 2010, the average yearly cataract surgery rate in Taiwan was 5350/million people. Taiwan has held many international congresses. The major areas of biomedical research in ophthalmology in Taiwan are ophthalmic epidemiology, glaucoma, vitreoretinal diseases, cornea, and stem cells. From 1990 to 2010, Taiwan ophthalmologists have published 15 monographs, 15 textbooks, and 2184 scientific articles. The future objectives of Taiwanese ophthalmologists are to promote preventive ophthalmology, to expand efforts in basic research, to establish a national eye-diseases registry, and to support the Taiwan Journal of Ophthalmology in becoming a Science Citation Index journal.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Thyroid eye disease (TED) is a complex inflammatory disease with a poorly understood etiopathogenesis. It is often, but not always, associated with Graves’ disease and the endocrinologic manifestations of hyperthyroidism. Controversy exists regarding optimal treatment of hyperthyroidism especially with regard to the progression of orbitopathy. We review the literature examining the effectiveness of antithyroid drugs, radioactive iodine, and thyroidectomy for long-term endocrinologic management, and their effect on the progression of TED. In formulating an individualized treatment plan, considerations include rates of recurrent hyperthyroidism, treatment-associated complications, and effect on TED progression.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Systemic corticosteroid may play a vital role in treating nonarteritic ischemic optic neuropathy (NAION). An intravitreal route provides the advantage of avoiding systemic side effects. In this study, we investigated the treatment result of intravitreal injection of acetonide (IVITA). Methods: We retrospectively reviewed six patients with NAION who were treated with a single IVITA. The patients were followed monthly for 6 months. Results: Visual acuity improved in three patients. One patient also had a better visual field at the 6^th month follow up. Two patients with more severe swelling of the optic disc initially did not gain better visual acuity. One patient with a pre-existing epiretinal membrane maintained stable visual acuity. Conclusion: Some patients with NAION may improve with IVITA treatment. Further randomized controlled clinical trials are needed.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

We report an extremely rare case of bilateral total limbal stem cell deficiency (LSCD) induced by long-term systemic chemotherapy for squamous cell carcinoma of the lung, and the outcomes of bilateral keratolimbal allograft transplantation (KLAT) in such a case. A 34-year-old male patient had underlying disease of squamous cell carcinoma in the right upper lung with extensive mediastinum and lymph node metastasis and received a series of systemic chemotherapy, including a combination of vinorelbine and cisplatin and a combination of gemcitabine, cisplatin, and docetaxel. According to clinical manifestations of ocular surface disorder, pathology findings, and immunostaining of cytokeratin 13 (CK13), LSCD secondary to systemic chemotherapy was diagnosed. KLAT was performed in both eyes. Although graft rejection developed in the right eye, complete re-epithelialization with favorable visual acuity occurred in the left eye 3 years after limbal transplantation.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Aim: To evaluate the anatomical and visual outcomes as well as the safety of combination therapy with dexamethasone intravitreal implant (0.7 mg) and bevacizumab in macular edema secondary to vascular occlusions. Methods: In this interventional, prospective case series all patients received dexamethasone implant and bevacizumab in a single sitting. Patients diagnosed with retinal venous occlusion were monitored for changes in visual acuity and macular thickness. All patients underwent detailed ocular examination, best corrected visual acuity (BCVA), and optical coherence tomography examination at baseline and at Week 1, Month 1, and monthly thereafter for 6 months. Results: Twenty four eyes of 24 treatment-naïve patients (central retinal venous occlusion, n = 9; branch retinal venous occlusion, n = 15) were identified. BCVA improved in 23 patients (95.83%) during the study period. Mean BCVA gained was 0.313 ± 0.26 (85.3% of final gain) and 0.367 ± 0.34 at Week 1 and Month 6, respectively. The percentage of patients who gained ≥2 lines were 52% at Week 1 and 68% at Month 6. The mean macular thickness reduced by 350.9 μm at Week 1 and the maximum treatment effect was seen at Month 2 (379.1 μm). Recurrence of macular edema was seen in 37.5% (9/24) of the eyes. Reinjection was needed, on average, at approximately 3.7 months from the first injection. Conclusion: This study demonstrates that the combination therapy of bevacizumab and dexamethasone implant given simultaneously is safe and synergistic resulting in significantly early and sustained visual recovery and decreased macular edema in patients having retinal vein occlusions.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

A 41-year-old female was diagnosed with retinitis pigmentosa (RP) after bilateral implantation of multifocal intraocular lenses (IOLs). Due to persistent dissatisfaction with her visual performance, she came to our hospital for medical help. We exchanged the multifocal IOL in the dominant eye with a monofocal IOL (hybrid monovision therapy), and the visual inconvenience was alleviated to a large extent. To our knowledge, this is the first case report on the effect of hybrid monovision therapy applied to a patient with RP.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

The aim of this study was to report cases that had used mini-scleral lenses to manage keratoconus and post-laser-assisted in situ keratomileusis (LASIK) ametropia and keratectasia. The first patient was a 32-year-old man who came to our clinic seeking to correct his vision. Following the LASIK procedure, his refraction gradually shifted toward hyperopia. He initially tried wearing spectacles and traditional rigid gas permeable (RGP) lenses, neither of which showed improvement. The second patient was a 28-year-old woman who complained of gradually worsening vision in her right eye after having received LASIK. She was diagnosed with corneal ectasia after a complete ophthalmic examination. She tried wearing spectacles and soft contact lenses, but neither showed any improvement. The third patient was a 29-year-old man with a long history of poor vision. He was first diagnosed with keratoconus in our clinic. He initially tried wearing a Rose K contact lens for the keratoconus in his right eye, but the lens rode low. After the initial treatment attempts, all three patients tried mini-scleral lenses, and their visual acuity improved to between 20/50 and 20/20. They were all able to wear the lenses for more than 10 hours a day without feeling any discomfort. In conclusion, mini-scleral lenses provide better comfort and vision in patients with keratoconus and post-LASIK keratectasia and ametropia.

[ABSTRACT]  [FULL TEXT]  [PDF] [CITATIONS]