Korean journal of ophthalmology : KJO最新文献

Purpose: To investigate ocular manifestation of immune reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV) patients after starting highly active antiretroviral therapy (HAART) and its relationship to T cell immunity.

Methods: HIV patients with ocular IRIS after HAART were retrospectively reviewed. Clinical presentations with previous opportunistic infection, duration from initiation of HAART to IRIS, blood CD4+, CD8+ T cell count, and HIV RNA copies before HAART and at IRIS were analyzed.

Results: Among 19 patients (27 eyes) included, the most common previous opportunistic infection was cytomegalovirus (17 patients, 89.5%) followed by tuberculosis choroiditis (2 patients, 10.5%). The clinical manifestations included vitritis (20 eyes, 74.0%), retinitis (14 eyes, 51.9%), and anterior uveitis (5 eyes, 18.5%). The median duration from initiation of HAART to IRIS was 70 days. CD4+ T cell count before HAART increased at IRIS (p<0.001). CD8+ T cell count before HAART was negatively correlated with duration from HAART to IRIS (p<0.001). Cut-off value of CD8+ T cell count for discerning early or late onset of ocular IRIS was 258/mm3 (p=0.001). When divided into two groups by CD8+ T cell count of 258/mm3, 90% patients with CD8+ T cell count higher than 258/mm3 before HAART developed ocular IRIS within 70 days.

Conclusions: There was negative relationship between CD8+ T cell count before HAART and duration from HAART to ocular IRIS. Ocular IRIS with higher CD8+ T cell count before HAART developed earlier after HAART initiation compared to those with lower CD8+ T cell count.

Purpose: To analyze the frequency, and clinical characteristics of ocular injuries in patients with prior blow-out fractures who experience new blunt trauma, and to assess whether old orbital fractures provide a protective effect against subsequent ocular trauma.

Methods: The medical records of 1,315 ocular trauma patients were reviewed. A total of 927 patients who had orbital or facial CT scans and ophthalmologist evaluations were considered. After applying exclusion criteria, 568 patients with 581 affected eyes were included in the final analysis. The patients were divided into two groups based on the presence of old blow-out fractures, identified on CT scan. The clinical characteristics and the frequency of ocular injuries were compared between the two groups. The risk of ocular injury according to the presence of old blow-out fracture ware studied using multiple logistic regression after controlling age and sex.

Results: Among the 581 eyes examined, 140 (24.1%) had old blow-out fractures. The incidence of intraocular complications was significantly higher in the no orbital fracture group (20.4%) compared to the old blow-out fracture group (2.1%) (p < 0.001). Specifically, the incidence of complications such as gross hyphema (p = 0.001), globe rupture (p = 0.006), and vitreous hemorrhage (p = 0.027) was significantly greater in the group without old blow-out fractures than in those with them. Multiple logistic regression showed that the presence of old blow-out fractures was significantly associated with reduced risk of ocular injury (p < 0.001).

Conclusions: The patients with old blow-out fractures had a lower risk of ocular injuries following subsequent blunt trauma. The findings suggest that old fractures may provide protective effect. These results may have important implications for the clinical management of patients at risk of recurrent orbital trauma.

Purpose: To evaluate the accuracy of toric intraocular lens (IOL) axis prediction between two preoperative measurement devices: the optical biometry (IOLMaster 500 or 700) and the dual Scheimpflug topography (Galilei G4).

Methods: Medical records of 64 eyes from 44 patients who underwent phacoemulsification and posterior chamber toric IOL (Zeiss AT TORBI 709M) implantation between July 2017 and January 2022 were reviewed. All patients underwent preoperative evaluation by optical biometry (IOLMaster 500 or IOLMaster 700) and Galilei G4. The gold-standard axis that minimizes astigmatism was calculated by the online Toric Results Analyzer postoperatively and compared to the preoperative toric IOL axis calculated by the Z CALC online IOL calculator using parameters from either IOLMaster or Galilei G4. The axis error (AE) and the absolute axis error (AAE) between the gold-standard axis and the preoperative calculated axis were analyzed to assess the accuracy of each device.

Results: Mean flat keratometry (K) and steep K were 42.99 diopter (D) and 45.61 D in IOLMaster, and 43.04 D and 45.51 D in Galilei G4, which did not show any significant difference. Mean keratometric astigmatism (KA) was 2.62 D in IOLMaster and 2.46 D in Galilei G4, which also did not show any statistical difference. KA axis did not show any significant difference between IOLMaster and Galilei G4. The mean AE and AAE were 0.19° and 6.84° by IOLMaster, and -0.80° and 7.98° by Galilei G4. The AE and AAE by IOLMaster did not show any significant difference compared to those of Galilei G4 (p=0.583, p=0.346, respectively).

Conclusions: This study suggests that the Galilei G4 demonstrated a similar level of accuracy to the IOLMaster in predicting the toric IOL axis, based on the gold standard axis provided by the toric results analyzer.

Purpose: To evaluate the differences in the level of concerns regarding exotropia surgery according to the perspectives regarding surgery and basic characteristics of parents of pediatric patients with intermittent exotropia in Korea.

Methods: This study included the parents of pediatric patients with intermittent exotropia who underwent surgery at five hospitals, between June 2022 and February 2023. Parental perspectives, basic characteristics, and levels of concern regarding surgery were assessed using a questionnaire. We investigated the differences in concern levels according to perspectives regarding surgery and basic characteristics among parents, such as sex, age, residential area, and the most influential factors in the decision-making for surgery.

Results: Two hundred sixty-six parents were included (age: 40.0±4.7 years, 228 mothers). Parents who chose surgery for subjective symptoms had higher levels of concern about hemorrhage, conjunctival redness, and persistent overcorrection than did those who chose surgery for cosmetic reasons (All p<0.05). Fathers were more concerned about postoperative pain, compared with mothers (p=0.039). Parents in their 40-50s had higher levels of concern about the hospital environment compared with those in their 20-30s (p=0.003). Concern did not significantly differ by residential area.

Conclusions: The level of concern regarding surgery differed according to the perspectives and characteristics of the parents of pediatric patients with intermittent exotropia. Parents who chose surgery for subjective symptoms of exotropia had a higher level of concern than did those who chose surgery for cosmetic reasons. The concern level differed according to the parents' sex and age but not their residential area.

Purpose: To compare the clinical outcomes of Xen 45 gel stent implantation surgery (Ab externo, open conjunctiva) with those of trabeculectomy.

Method: We retrospectively reviewed electronic medical record of 57patients (62eyes) treated with Xen implantation surgery (ab externo, open conjunctiva approach) between April 1st, 2021 and July 31st, 2023 by the same surgeon. Preoperative clinical data including intraocular pressure, the number of glaucoma medications, visual acuity were collected from 1 day to 12 months postoperatively. These data were compared and analyzed with those of 67patients (78eyes) received trabeculectomy between February 1st, 2017 and April 30th, 2022 by the same surgeon. Statistical analyses were performed with P<0.05 as significant.

Results: Complete surgical success rate was 33.9% and 57.7% of the Xen and trabeculectomy groups, respectively(p=0.005). Qualified success rate was 79.0% and 93.6%, respectively(p=0.011). Postoperatively, the Xen group used more glaucoma medications than the Trabeculectomy group (1.21±1.05 vs. 0.69±0.90; p=0.003, at postoperative month 12). After postoperative month 1, the Xen group had a higher IOP (15.77±5.07 mmHg vs. 13.17±3.81 mmHg; p=0.001, at postoperative month 12) and lower corneal astigmatism than the trabeculectomy group (1.32±0.79 vs. 1.88±1.45; p=0.020, at postoperative month 6). There was no significant difference in pre- and postoperative best corrected visual acuity (logMAR) between the groups at any of the follow-up period (favorable VA subgroup; logMAR<0.7). Postoperative complications were 0 case of Xen group and 13 cases of trabeculectomy group (0% vs. 16.7%; p=0.001). Also, Xen surgery(24minutes 40seconds±6minutes 26seconds) had a shorter operation time than the trabeculectomy(40minutes 18seconds±8minutes 27seconds; p<0.001).

Conclusion: Compared to trabeculectomy, Xen surgery (Ab externo, open conjunctiva) showed relatively lower effectiveness (surgical success rate, IOP reduction). However, it demonstrated advantages as a MIGS, including a surgical success rate approaching about 80%, stability in inducing corneal astigmatism, fewer postoperative complications, and shorter operation times.