Korean journal of ophthalmology : KJO最新文献

Purpose: To investigate the retinal vascular abnormalities in both affected and fellow eyes of presumed unilateral Coats' disease patients using ultra-wide-field fluorescein angiography (UWF-FA) and their association with visual prognosis.

Methods: A retrospective review of 30 patients diagnosed with presumed unilateral Coats' disease, evaluated with UWF-FA from March 2003 to May 2024 in a tertiary referral hospital. Clinical features and multimodal imaging findings were evaluated and factors related to final visual outcomes were analyzed.

Results: All 30 patients were diagnosed with presumed unilateral Coats' disease at presentation, comprising 36.7% childhood-onset and 63.3% adult-onset patients. Retinal vascular telangiectasia was observed in 51.7% of fellow eyes. The extent of telangiectasia and exudate in the affected eyes did not significantly correlate with extent of telangiectasia in the fellow eyes. In the more affected eyes, the childhood-onset group had a significantly greater extent of capillary drop-out compared to the adult-onset group (5.0 vs 2.8 clock hours, p = 0.023). In the fellow eyes, telangiectasia tended to be more frequent in the childhood-onset group (63.6% vs. 44.4%), without significance (p = 0.160). In the multivariable regression analysis, the final best-corrected visual acuity (BCVA) in the more affected eye was significantly associated with initial BCVA. The mean extent of telangiectasia in the temporal and nasal quadrants and the initial BCVA of the more affected eyes were identified as prognostic factors for final moderate to severe visual loss (Snellen BCVA < 20/66) (OR = 12.8, p = 0.043; OR = 11.8, p = 0.024, respectively).

Conclusions: About half of presumed unilateral Coats' disease cases exhibited features of bilateral disease. Visual prognosis is associated with the peripheral retinal telangiectasia in the temporal and nasal quadrants as well as initial BCVA in the affected eyes while it is not associated with retinal vascular abnormalities in the fellow eyes.

Purpose: To evaluate the surgical outcomes of a modified normogram for bilateral lateral rectus recession (BLR) in the surgical management of intermittent exotropia, with a focus on achieving small overcorrection.

Methods: A retrospective medical chart review of 242 patients who underwent surgery for intermittent exotropia between October 2014 and June 2020 was performed. Our modified normogram reducing amount of recession targeted for small postoperative overcorrection within 5 prism diopters (PD). Patients were observed for at least 3 years. Esodeviation was denoted by negative numbers and positive values indicated exodeviation. A satisfactory outcome was defined as if distant angle of deviation ranged between ≤10 PD of exotropia and ≤5 PD of esotropia. Recurrence was defined as an exodeviation of >10 PD at distance. Overcorrection was defined as an esodeviation of >5 PD at distance.

Results: The mean preoperative deviation angles were 29.32±3.92 PD at distance and 29.88±4.41 PD at near. At postoperative day 1, the mean deviation angles at distance and near were -6.22±1.44 PD and -6.22±1.49 PD, respectively. Overcorrection within 6 PD of esodeviation was seen in 168 patients (69.42%), undercorrection with exophoria was noted in 11 patients (4.55%), and overcorrection by more than 6 PD of esodeviation was seen in 63 patients (26.03%) at postoperative day 1. The long-term success rate at postoperative 3 years was 77.27% (187/242), with a recurrence rate of 19.83% (48/242) and an overcorrection rate of 2.89% (7/242). A positive correlation between the angle of deviation at postoperative day 1 and 3 years was observed (r= 0.22, p=0.001). The final success rate at the final examination after a mean follow-up of 38.60±7.99 months was 83.06%.

Conclusion: Our modified normogram for BLR in intermittent exotropia surgery resulted in successful surgical outcomes with small overcorrection, reducing the risk of consecutive esotropia due to excessive overcorrection.

Purpose: To investigate the clinical features and visual outcome of infectious keratitis associated with Orthokeratology (Ortho-K) lens in Korean pediatric patients.

Methods: We retrospectively reviewed medical records of patients diagnosed with Ortho-K lens-associated infectious keratitis from June 2005 to April 2020 at a tertiary referral hospital. Patients' demographics, clinical features, microbiological evaluation, and treatment methods were assessed and factors related to final visual outcomes were analyzed.

Results: The study included 26 eyes of 26 patients (19 female, 7 male; mean age: 11.9 years), with an average Ortho-K lens wear duration of 33.7 ± 21.2 months. The highest number of cases occurred in summer (42.3%, 11/26). Central or paracentral corneal lesions were observed in 96.2% (25/26) of cases, with a mean corneal epithelial defect size of 5.13 mm². Pseudomonas aeruginosa was the most commonly isolated organism (n = 5), followed by Serratia marcescens (n = 4). All patients responded to medical treatment without needing surgical intervention. 72% of cases achieved favorable visual outcomes (Snellen BCVA > 6/12), while 8% experienced severe visual impairment (Snellen BCVA ≤ 6/60) due to residual central corneal opacities. Multivariable analysis showed that non-summer seasons, duration from symptom onset to presentation, and corneal epithelial defect size were significantly associated with final logMAR BCVA (p = 0.043, p = 0.040, and p = 0.002, respectively). Failed autorefraction at presentation due to an Ortho-K-related infectious keratitis lesion was a significant predictor of poor final visual outcome (Snellen BCVA ≤ 6/12) (OR = 38.995, p = 0.030).

Conclusions: Ortho-K lens-related infectious keratitis can lead to permanent corneal opacities and potentially devastating visual outcomes in children. Delayed time to presentation, large corneal lesions, failure of autorefraction, and non-summer seasons were associated with poorer outcomes. Proper education and early detection would be key to safe use of orthokeratology lenses in pediatric patients.

Purpose: To evaluate two-year outcomes of intravitreal aflibercept injection for neovascular age-related macular degeneration (nAMD) treated with 'observe before treat-and-extend' (O-TAE) strategy in the real-world setting.

Methods: This retrospective study included treatment-naïve nAMD patients treated with aflibercept using O-TAE regimen and followed up for more than 2 years. Patients were observed bimonthly to check recurrence after 3 monthly loading injections. In case of recurrence, treatment was resumed using the treat-and-extend (TAE) regimen starting from the 4th injection. In case of non-recurrence, observation was continued. Best-corrected visual acuity (BCVA), central macular thickness (CMT), number of injections, TAE intervals, and proportion of recurrence after dry-up following 3 loadings were analyzed.

Results: 38 eyes of 34 patients were included. Follow-up period was 37.0 ± 11.0 months. BCVA by logMAR improved from 0.33 ± 0.29 at baseline to 0.24 ± 0.23 in the 1st year (p = 0.01), and 0.25 ± 0.22 in the 2nd year (p = 0.054). CMT decreased significantly from 357.4 ± 74.5 at baseline to 269.6 ± 48.1 in the 1st year (p < 0.001), and 279.1 ± 54.6 in the 2nd year (p < 0.001). Numbers of injections were 5.1 ± 1.7 in the first year and 3.8 ± 2.4 in the second year. The percentage of eyes with a TAE interval of ≥12 weeks was 37.0% in the first year and 34.4% in the second year. Of the 36 eyes that dried up after 3 loadings, 28 eyes (78%) recurred, and the average period of recurrence was 6.5 months. The remaining 8 eyes (22%) had no recurrence during the mean follow-up period of 29.7 months.

Conclusion: This study showed that the newly suggested O-TAE strategy can reduce the treatment burden significantly reducing the number of injections while improving BCVA and CMT in the first and second year.

Purpose: To compare changes in the swept-source anterior segment optical coherence tomography (SS AS-OCT) parameters and intraocular pressure (IOP) control after lens extraction in various spectra of primary angle closure disease (PACD).

Methods: A total 92 eyes from 92 patients with PACD who underwent lens extraction were included in the study. All patients underwent IOP measurement preoperatively and postoperatively at 1 day, 1 week, 1 month, 3 months, and 6 months. SS AS-OCT was performed in all subjects preoperatively and 1 month postoperatively. All participants were divided into two groups depending on the presence of glaucomatous optic disc or visual field damage (group A: primary angle closure suspect or primary angle closure; group B: primary angle closure glaucoma). The changes in IOP and anterior chamber angle (ACA) parameters of SS AS-OCT of each group were compared. Regression analysis was performed to find factors associated with the degree of IOP reduction after lens extraction.

Results: Preoperatively, there was no significant difference in IOP (16.3 ± 2.5 vs 16.9 ± 3.2 mmHg, P=0.297) between the two groups, but the number of glaucoma medications used (0.6 ± 1.0 vs 2.0 ± 0.9, P<0.001) was greater in group B. Postoperatively, IOP was not significantly different, but the number of medications used was greater in group B (0.2 ± 0.7, 0.9 ± 0.8, P<0.001). ACA parameters including angle opening distance and trabecular-iris angle had a greater increase in group B after lens extraction. However, the residual iridotrabecular contact (ITC) index (5.6 ± 7.0 vs 10.7 ± 12.1, P=0.014) was significantly greater in group B. A greater change in the ITC index was related to a greater degree of IOP reduction (beta coefficient = 0.429, P<0.001).

Conclusions: Eyes with PACG had a greater residual ITC index after lens extraction compared with eyes of other PACD spectrum, and required a greater number of glaucoma medications to maintain a similar level of IOP.

Purpose: There has been a lack of data on health-related quality of life (HRQoL) in children with vernal keratoconjunctivitis (VKC) from South East Asia. This study evaluated the levels (mean total score and subscales score) of HRQoL, comparing the VKC and normal children groups, and within the VKC severity groups.

Methods: A cross-sectional study was conducted in two tertiary hospitals, specifically the pediatric ophthalmology services at Hospital Hospital Selayang and Universiti Sains Malaysia, spanning from 2019 to 2020. Participants aged 8 and 15 were categorized into two groups; those diagnosed with VKC and healthy children serving as the control group. Each participant completed the Quality of Life in Children with Vernal Keratoconjunctivitis (QUICK) questionnaire, consisting of 16 questions, divided into two subscales: 12 questions focusing on symptoms and four questions for daily activities.

Results: A total of 240 children took part in the study, with 120 children diagnosed with VKC and another 120 in the control group. The mean age of participants with VKC was 11.21 (1.91) years, with a male predominance of 4:1 compared to females. Tearing (98.4%) and itchiness (98.3%) emerged as the most prevalent symptoms affecting HRQoL, while the most challenging activities were outdoor play (36.6%) and participation in recreational water activities (34.2%). The mean total score was significantly higher in the VKC group compared to the control group. Additionally, both the mean total score and all subscale scores were significantly higher in the severe type compared to the mild-moderate type.

Conclusions: VKC significantly reduce the HRQoL among Malaysian children, and the negative impact increases with the disease severity.

Purpose: This study aimed to determine the changes in choroidal thickness induced by pioglitazone in diabetic patients.

Methods: A total of 261 patients diagnosed with type 2 diabetes who had taken oral pioglitazone for more than 6 months were included in the study. After excluding patients who did not undergo regular eye examinations or who had ophthalmic surgery/interventions during the treatment period, a total of 40 eyes were included. The study examined the duration and dosage of pioglitazone, patient age, ocular axial length, refraction, glycated hemoglobin, systolic blood pressure, corrected visual acuity, macular thickness, choroidal thickness, and choroid vascular index. Patients were categorized into a high dose group if their pioglitazone dose was 30mg or more per day, and a low dose group if it was 15mg or less. Choroidal thickness was measured below the subfovea and a 500 µm radius nasal and temporal to that location.

Results: Choroidal thickness significantly increased after 6 and 12 months of pioglitazone in all subjects (6.70µm, 13.65µm, each). When stratified by pioglitazone dosage, choroidal thickness increased at 6 and 12 months in both the high (4.48µm, 0.84µm, each) and low dose groups (6.85µm, 21.45µm, each), with a greater change observed in low dose group (p<0.05, respectively). Based on the location of choroidal thickness measurements, a significant increase in choroidal thickness was observed at 6 and 12 months of pioglitazone treatment in the subfoveal (7.00µm, 13.15µm, each) and nasal regions (6.43µm, 19.24µm, each), while a significant increase was only observed after 6 months of treatment in the temporal region (8.53µm) (p<0.05, respectively). The largest increase in choroidal thickness was observed in the nasal side.

Conclusion: This study found that choroidal thickness increased in diabetic patients after taking pioglitazone. Regular eye examinations are recommended for diabetic patients who are on pioglitazone.

Purpose: This study aims to evaluate the impact of upper eyelid blepharoplasty on perceived age, attractiveness, success, and overall health as rated by observers.

Methods: A web-based survey was conducted with 203 observers who were unaware of the study's purpose. They assessed pre- and post-operative images of 12 female patients using the Delphi method to ensure appropriate image selection and unbiased ratings. Observers rated the images on a visual analog scale from 0 to 10, where higher scores indicated more favorable perceptions.

Results: The observer group consisted of 108 females (53.2%) and 95 males (46.8%), with an age range of 18 to 61 years. The mean age perceived by observers decreased from 51.75 before surgery to 42.10 after surgery, indicating a significant reduction in perceived age (p=0.01). Additionally, post-surgical assessments showed significant increases in perceived attractiveness, success, and overall health.

Conclusion: Upper eyelid blepharoplasty significantly enhances how patients are perceived in terms of youthfulness, attractiveness, and success. These findings underscore the positive impact of cosmetic eyelid surgery on public perception.

Purpose: To compare corneal higher order aberrations (HOAs) in patients with epiphora caused by unilateral primary acquired nasolacrimal duct obstruction (PANDO) and their fellow eyes.

Methods: One hundred twenty two eyes of 61 patients with unilateral PANDO were included. Affected eyes named as Group 1 and contralateral eyes named as Group 2. Munk scale and fluorescein dye disappearance test (FDDT) were assessed. Corneal topographic and HOAs measurements were taken by Sirius topography.

Results: There were 47 female and 14 male patients. The mean Km were 43.84± 1.4 in Group 1 and 43.96± 1.4 in Group 2 (p=0.73). The mean corneal topographic astigmatism were 0.81± 0.7 in Group 1 and 0.78± 0.5 in Group 2 (p=0.57). The mean coma-like aberration was 0.19± 0.2 in Group 1 and 0.1± 0.1 in Group 2 (p=0.03). The mean spherical-like aberration was 0.16± 0.1 in Group 1 and 0.11± 0.1 in Group 2 (p=0.04). The mean total corneal HOA was 0.3±0.5 in Group 1 and 0.23±0.2 in Group 2 (p=0.04). The mean munk score was 3.47± 1 in Group 1. There was a positive correlation between munk score and coma-like aberration and total corneal HOAs levels (r=0.53; p=0.003 and r=0.44; p=0.01 respectively). The mean FDDT was grade 2.6± 0.1 in Group 1. There was a positive correlation between FDDT grade and coma-like aberration and total corneal HOAs levels (r=0.48; p=0.001 and r=0.33; p=0.001 respectively).

Conclusions: Epiphora in patients with PANDO can affect corneal HOAs. As patients symptoms and tear pooling were increased corneal HOA levels increased.