Hypotony maculopathy and photoreceptor folds with disruptions after vitrectomy for epiretinal membrane removal: two case reports

Background Hypotony maculopathy has been classically reported as a complication of glaucoma surgery or ocular trauma. There have been only a few reports of hypotony maculopathy following pars plana vitrectomy (PPV). Here, we report two cases of hypotony maculopathy occurring after PPV for epiretinal membrane (ERM) removal and characteristic photoreceptor folds observed on optical coherence tomography (OCT). Case presentation A 53-year-old Korean woman (case 1) underwent phacoemulsification and posterior chamber lens implantation combined with 25-gauge PPV for ERM removal in the right eye. On the following day, she had severe ocular hypotony, with an intraocular pressure (IOP) that was unmeasurable using a pneumatic tonometer. Despite normalization of IOP, macular retinal and photoreceptor folds with photoreceptor disruptions developed, and Henles fiber layer hyperreflectivity was identified. Thereafter, retinal and photoreceptor folds gradually disappeared but photoreceptor disruption and Henles fiber layer hyperreflectivity did not improve until 1 year postoperatively, with persistent central visual field distortion and visual acuity worse than that at the preoperative state. A 20-year-old Korean man (case 2) underwent an additional 25-gauge PPV for ERM removal in the left eye. Examination on the following day showed ocular hypotony and retinal folds with peripheral choroidal detachment. Although IOP was normalized, further OCT revealed photoreceptor folds and photoreceptor disruptions. Since then, the photoreceptor folds resolved; however, the photoreceptor disruption remained in the macula at the 1-year follow up, with persistent distorted vision and visual acuity worse than that at the preoperative state. Conclusions Early hypotony after vitrectomy for ERM could result in maculopathy leading to irreversible visual decline and metamorphopsia. Photoreceptor folds on OCT are characteristic features and the predominant mechanism of central visual loss in cases of hypotony maculopathy.This work was supported by a National Research Foundation of Korea (NRF) Grant funded by the Korean government (MSIT) (No. 2020R1F1A1072795). The funding organization had no role in the design or conduct of this stud

Surgical outcomes of strabismus after iatrogenic ophthalmic artery occlusion caused by cosmetic filler injections

Background To investigate the surgical outcomes of strabismus related to iatrogenic occlusion of the ophthalmic artery and its branches from cosmetic facial filler injection. Methods A retrospective study was performed on 6 patients who underwent strabismus surgery among 23 patients who had suffered occlusion of the ophthalmic artery and its branches after cosmetic facial filler injection. Initial, preoperative and final ocular motility examinations, the type of surgery and surgical outcomes were evaluated. Results At initial presentation, visual acuity was no light perception in 5 patients and hand motion in one patient. Five out of 6 patients showed initial ophthalmoplegia. Among these 5 patients, eye motility fully recovered in 3 patients although sensory strabismus developed during follow-up, while the remaining 2 patients had persistent ocular motility limitations. Strabismus surgery was performed at 2.2 ± 1.5 years after iatrogenic ophthalmic artery occlusion. Preoperatively, 5 of the 6 patients showed exotropia, and one patient had esotropia. Vertical deviation was found in 3 out of 6 patients in addition to the horizontal deviation. Successful outcome was achieved only in the 4 patients without persistent ophthalmoplegia after 1.4 ± 1.0 years from surgery. The other two patients with persistent ocular motility limitations failed to achieve successful alignment after surgery, and one patient eventually underwent evisceration due to phthisis bulbi. Conclusions In our study, surgical outcomes of strabismus caused by cosmetic facial filler injection were successful only in patients without persistent ophthalmoplegia at the time of surgery.This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No.2017R1A2B4011450). The funding organization had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

A Neurostimulator Design for Long-term Animal Experiments

This article reports on a neural prosthesis stimulation system for long-term use in animal electrical stimulation experiments. The presented system consists of an implantable stimulator which provides continuous electrical stimulation, and an external component which provides preset stimulation parameters and power to the implanted stimulator via a paired RF (radio frequency) coil. A rechargeable internal battery and a parameter memory component were introduced to the implanted neural stimulator. As a result, the external component was not necessary during the stimulation cycles. The implantable stimulator was implemented with IC chips and the electronics, except for the stimulation electrodes, were hermetically packaged in a biocompatible metal case. A polyimide-based gold electrode array was used for realization of the animal implantation test using retinal prosthesis approach.This work was supported by the Korean Science and Engineering Foundation (KOSEF) through the Nano Bioelectronics and Systems Research Center (NBS-ERC) of Seoul National University under Grant R11-2000-075-01001-0 and by the Ministry of Health & Welfare, Republic of Korea through the Nano Artificial Vision Research Center under Grant of the Korea Health 21 R&D Project (A050251)

Combined Photodynamic Therapy and Intravitreal Bevacizumab Injection for the Treatment of Adult Coats' Disease: A Case Report

A 68-year-old woman presented with a visual field defect in her right eye. The fundus of her right eye showed multiple telangiectatic vessels, retinal hemorrhages, and subretinal exudates in the inferior peripheral retina. Nine months later, the subretinal exudates extended to the fovea despite treatment with laser photocoagulation. Cryotherapy was not possible at the time because of the posterior location of the retinal telangiectatic vessels. She was treated with a combination of photodynamic therapy (PDT) and intravitreal bevacizumab injection: three injections were given at 2-month intervals. After this combined therapy, her right fundus revealed a significant regression of abnormal retinal vessels and subretinal exudates. A fluorescein angiography showed no leakage from the abnormal retinal vessels. At 9 months after the combined therapy, she was able to maintain a stable visual acuity and visual field. This is the first case report that demonstrates the efficacy of the combined treatment of PDT and intravitreal bevacizumab injection in Coats's disease. This combined therapy is a kind of treatment modality for adult Coats' disease in cases which cryotherapy cannot be employed and are refractory to laser photocoagulation

Association of Alcohol Consumption with the Risk of Ocular Trauma

This study was conducted to evaluate the influence of alcohol consumption on the risk of ocular trauma. We retrospectively reviewed the medical records of 1,024 patients who visited emergency department and received ophthalmologic examination from January 1 to December 31, 2009. The patients were divided into 2 groups: those with ocular trauma (n = 494) and those without (n = 530); the influence of alcohol consumption was compared between these 2 groups. In the ocular trauma group, the association of the causes and types of ocular trauma with alcohol consumption was evaluated. One of 530 patients of no trauma group and 117 (23.7%) of 494 patients of trauma group were related with alcohol intake, and the difference was statistically significant (P < 0.001). Concerning the causes, physical assault was significantly more common in alcohol-associated injury (P < 0.001). Regarding the types of injury, orbital wall fracture and hyphema showed a significant association with alcohol consumption (P < 0.001). Older age and nighttime injury were significantly related to the increased risk of alcohol-associated ocular trauma (P = 0.018 and < 0.001, respectively). In conclusion, alcohol consumption significantly increases the risk of ocular trauma

Acute-Onset Bilateral Myopia and Ciliochoroidal Effusion Induced by Hydrochlorothiazide

The authors experienced two cases of hydrochlorothiazide (HCTZ)-induced acute-onset bilateral myopia and shallowing of the anterior chambers. Two middle-aged women taking HCTZ, a sulfa derivative, visited our clinic complaining of acute bilateral visual deterioration. Both had good visual acuity without corrective lenses before taking HCTZ. A complete ophthalmologic examination revealed bilateral myopic shift, intraocular pressure elevation, shallowing of the anterior chambers, choroidal effusions, radiating retinal folds, and conjunctival chemosis. Approximately one week after HCTZ discontinuance, all ocular changes disappeared completely. Physicians should be aware of the adverse ocular effects of HCTZ and should manage patients accordingly

Increasing trend in rhegmatogenous retinal detachment in Korea from 2004 to 2015

Background To determine the 12-year incidence of and trends in rhegmatogenous retinal detachment (RRD) requiring surgery in Korea. Methods This was a nationwide, population-based, retrospective study. We identified 53,179 patients with incident RRD requiring surgery using the Korean National Health Claims Database from 2004 to 2015. We estimated the crude incidence rates and age- and sex-standardized incidence rates per 100,000 person-years in each year during the study period. A joinpoint regression analysis was performed to determine the trend. Results The average annual incidence rate was 9.78 (95% CI: 9.70–9.86). Male patients showed an incidence rate (10.68 [95% CI: 10.57–10.80]) 1.20 times that of female patients (8.87 [95% CI: 8.76–8.98]). The incidence showed a bimodal distribution; the highest peak was in the 60–64 year age group (23.77 [95% CI: 23.18–24.35]) and the second peak was in the 20–24 year age group (7.68 [95% CI: 7.41–7.95]). An increasing trend of RRD incidence was observed in the total population throughout the study period using joinpoint analysis (annual percentage change [APC], 2.05; 95% CI: 0.7–3.4). The increasing trend was more prominent among individuals aged under 50 years (APC, 3.44; 95% CI: 2.3–4.6), while among those aged 50 years or above, the increasing incidence was observed only in male patients. Conclusions In Korea, the incidence of RRD has increased recently. People in the < 50 year age group accounted for the major part of this significant increase, which is related to the increasing incidence of myopia in the young generation in Asia.This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant Number: HI19C0373)