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   2015| January-March  | Volume 5 | Issue 1  
    Online since February 17, 2015

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Traumatic optic neuropathy—Clinical features and management issues
Patrick Yu-Wai-Man
January-March 2015, 5(1):3-8
DOI:10.1016/j.tjo.2015.01.003  PMID:26052483
Traumatic optic neuropathy (TON) is an uncommon cause of visual loss following blunt or penetrating head trauma, but the consequences can be devastating, especially in cases with bilateral optic nerve involvement. Although the majority of patients are young adult males, about 20% of cases occur during childhood. A diagnosis of TON is usually straightforward based on the clinical history and examination findings indicative of an optic neuropathy. However, the assessment can be difficult when the patient’s mental status is impaired owing to severe trauma. TON frequently results in profound loss of central vision, and the final visual outcome is largely dictated by the patient’s baseline visual acuities. Other poor prognostic factors include loss of consciousness, no improvement in vision after 48 hours, the absence of visual evoked responses, and evidence of optic canal fractures on neuroimaging. The management of TON remains controversial. Some clinicians favor observation alone, whereas others opt to intervene with systemic steroids, surgical decompression of the optic canal, or both. The evidence base for these various treatment options is weak, and the routine use of high-dose steroids or surgery in TON is not without any attendant risks. There is a relatively high rate of spontaneous visual recovery among patients managed conservatively, and the possible adverse effects of intervention therefore need to be even more carefully considered in the balance.
  1,250 151 13
Severe ocular complications following facial calcium hydroxylapatite injections: Two case reports
Yun-Han Hsieh, Chao-Wen Lin, Jen-Shang Huang, Po-Ting Yeh
January-March 2015, 5(1):36-39
DOI:10.1016/j.tjo.2014.03.009  PMID:29018663
Dermal soft-tissue augmentation using a filler is a technique widely used for facial cosmetic enhancement. However, potential complications following facial cosmetic injections have heightened the possibility of iatrogenic visual loss. We report two cases of severe ocular complications after nasal cosmetic enhancement. Both cases had poor visual outcomes in spite of emergency management. The second patient is a rare case with bilateral anterior ischemic optic neuropathy after dermal soft-tissue augmentation. The visual outcome was correlated with the location and the extent of the arterial embolization. Unfortunately, there is still no standard treatment protocol for vision-threatening complications. Clinicians should always keep in mind that embolic arterial occlusion may occur after augmentation.
  1,015 76 9
How to manage traumatic optic neuropathy?
An-Guor Wang
January-March 2015, 5(1):1-2
DOI:10.1016/j.tjo.2015.01.002  PMID:29018656
  935 74 -
Major challenges in vitreoretinal surgery
Yijun Hu, Shibo Tang
January-March 2015, 5(1):9-14
DOI:10.1016/j.tjo.2014.04.005  PMID:29018657
Since the first vitrectomy surgery was used for treatment of vitreoretinal diseases, surgical techniques and instrumentation have been rapidly improved in the past decades. However, there are complicated vitreoretinal diseases that cannot be successfully treated, even with state-of-the-art surgeries. The outcomes of some complicated cases are still poor due to different reasons and debates still remain in some areas regarding what are the best treatments. There is still a lack of full understanding on many complicated vitreoretinal diseases, such as the molecular basis of proliferative vitreoretinopathy (PVR), the role of scleral buckling (SB) in the management of rhegmatogenous retinal detachment (RRD), the optimal surgical consideration for pediatric RD, and the possibility of surgical management for various retinal degenerations and congenital retinal anomalies. This review discusses the current understandings of some complicated vitreoretinal diseases.
  802 72 -
Experience of scleritis and episcleritis at a tertiary center in Southern Taiwan
Yun-Wen Chen, Yi-Chieh Poon, Hun-Ju Yu, Ming-Tse Kuo, Po-Chiung Fan
January-March 2015, 5(1):19-22
DOI:10.1016/j.tjo.2014.10.004  PMID:29018659
Purpose: The purpose of this study was to review the clinical experiences of scleritis and episcleritis in Southern Taiwanese people during a 7-year period. Methods: The charts of 89 patients (representing 101 eyes) who had visited our clinic from January 2003 to July 2010 were retrospectively reviewed. They were diagnosed as having episcleritis or scleritis. The medical charts, slit lamp photographs, and laboratory data were reviewed. Age, gender, laterality, previous surgery history, systemic diseases, follow-up duration, and ocular complications were collected. The patients were classified as having clinically suspected noninfectious scleritis (CSNIS), clinically suspected infectious scleritis (CSIS), and episcleritis for analysis. Results: In the series of 89 patients (i.e., 101 eyes), 31 (34.8%; 32 eyes) patients had scleritis and 58 (65.2%; 69 eyes) patients had episcleritis. Episcleritis and scleritis occurred slightly more frequently in women than in men. In the 31 patients (32 eyes) diagnosed with scleritis, 12 (38.7%) patients had CSIS and 19 (61.3%) patients had CSNIS. Patients with scleritis were older than patients with episcleritis (p < 0.001). Previous pterygium excision was associated with CSIS and necrotizing scleritis. Conclusion: Scleritis occurred in a more elderly population. It was more frequently associated with ocular complications, compared to episcleritis. Both CSNIS and CSIS were associated with a history of pterygium excisional surgery. Our series of patients had a high occurrence of necrotizing scleritis. All cases of necrotizing scleritis were associated with a history of previous ocular surgery.
  791 52 2
Neuroimaging and clinical features of patients with optic nerve hypoplasia in Taiwan
Hui-Chen Cheng, May-Yung Yen, An-Guor Wang
January-March 2015, 5(1):15-18
DOI:10.1016/j.tjo.2014.11.001  PMID:29018658
Purpose: To investigate the clinical and neuroradiographic features of Chinese patients with optic nerve hypoplasia (ONH). Methods: This was a retrospective case series study. The medical records and magnetic resonance imaging (MRI) studies of patients diagnosed with ONH from September 2001 to December 2013 in the neuro-ophthalmology clinic of Taipei Veterans General Hospital were reviewed. Results: A total of eight eyes of five patients with ONH were enrolled in this study (1 male, 4 females). The mean age at diagnosis was 14.5 ± 12.0 years (range 0.25–30 years). Ocular examination revealed approximately half of the eyes had tortuous retinal vessels. In MRI studies, all patients had midline brain abnormalities including ectopic posterior pituitary gland (60%), agenesis of septum pellucidum (20%), and Rathke’s cleft cyst (20%). Two patients had endocrinopathies—one suffered from hypopituitarism and the other had hyperprolactinemia. Both of them showed ocular findings of tortuous retinal vessels. Conclusion: A high prevalence of midline brain abnormalities was noted in ONH patients of Chinese ethnicity. The presence of tortuous retinal vessels in patients with a midline brain anomaly may indicate the occurrence of endocrinopathy.
  786 49 2
Bilateral optic neuritis related to chronic inflammatory demyelinating polyneuropathy
Kui-Yueh Lin, I-Hua Wang, Jieh-Ren Jou, Hai-Jui Chu, William Wei, Shwu-Huey Lee, Szu-Yuan Lin
January-March 2015, 5(1):40-43
DOI:10.1016/j.tjo.2014.04.002  PMID:29018664
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a condition that mainly affects the peripheral nervous system; however, the central nervous system has also been involved in rare cases. Herein, we describe the case of a 33-year-old man with CIDP who presented with progressively blurred vision and pain with eye movement in both eyes for 1 month. Ocular examination revealed reduced visual acuities of 0.15 (oculus unitas or OU) and unremarkable fundi (OU). Furthermore, bitemporal visual field defects and prolonged visually evoked potentials were evident. Brain magnetic resonance imaging revealed nothing remarkable along the optic nerve and chiasm. These findings were compatible with the diagnosis of bilateral optic neuritis. The patient’s symptoms and visual acuity improved after 5 days of intravenous (IV) corticosteroid pulse therapy, which was subsequently replaced by oral prednisolone therapy with a tapering schedule. The patient’s visual acuity returned to 1.0 (OU) 6 months after treatment. However, bilateral optic neuritis recurred in 7 months while the patient was on oral pred-nisolone and azathioprine. IV corticosteroid pulse therapy was subsequently reinitiated and the patient’s visual acuity returned gradually to 1.0 (OU). Bilateral optic neuritis is a rare manifestation of CIDP. It responded well to IV corticosteroid therapy in our case.
  760 47 4
Comparison of surgical outcomes after phacotrabeculectomy in primary angle-closure glaucoma versus primary open-angle glaucoma
Linda Yi-Chieh Poon, Ing-Chou Lai, Jong-Jer Lee, Jen-Chia Tsai, Pei-Wen Lin, Mei-Chin Teng
January-March 2015, 5(1):28-32
DOI:10.1016/j.tjo.2015.01.001  PMID:29018661
Purpose: To compare postoperative outcomes and assess factors associated with intraocular pressure (IOP) reduction after phacotrabeculectomy in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Methods: This is a retrospective study of patients who underwent phacotrabeculectomy between 2010 and 2013. Factors including age, gender, visual field (VF), the number of glaucoma medications used, biometric changes, IOP, and surgical success rates were compared between groups. Results: There were 27 PACG and 34 POAG patients. The PACG group had a greater mean IOP reduction after phacotrabeculectomy compared to the POAG group (5.5 ± 7.9 mmHg versus 2.0 ± 4.2 mmHg; p = 0.03). However, the final mean IOP was similar between the two groups (PACG: 12.2 ± 4.8 mmHg, POAG: 12.3 ± 3.1 mmHg; p = 0.92). Phacotrabeculectomy resulted in a mean decrease in axial length (AL) of 0.16 ± 0.15 mm in PACG and 0.16 ± 0.11 mm in POAG (p = 0.96), and an increase in anterior chamber depth (ACD) of 1.41 ± 0.91 mm in PACG, and 0.87 ± 0.86 mm in POAG (p = 0.04). At 2 years follow-up, the cumulative success rate of phacotrabeculectomy was 74% in PACG and 62% in POAG. Multivariate analysis found that early glaucoma stage, greater postoperative increase in ACD, and high preoperative IOP were factors associated with greater IOP reduction. Conclusion: Postoperative success rates and mean IOP on the final visit after phacotrabeculectomy were similar between the PACG and POAG groups. Factors associated with IOP reduction were greater postoperative increase in ACD, and high preoperative IOP.
  739 61 2
Management of hypotony after glaucoma filtering surgery
Pei-Kang Liu, Han-Yi Tseng, Kwou-Yeung Wu
January-March 2015, 5(1):44-47
DOI:10.1016/j.tjo.2014.05.003  PMID:29018665
A 39-year-old male with open angle glaucoma in both eyes visited our clinic. The intraocular pressure (IOP) of both eyes fluctuated between 15 mmHg and 25 mmHg. The best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/100 in the left eye. He underwent trabeculectomy with an adjunctive agent (mitomycin C; concentration, 0.2 mg/mL) smoothly on the right eye. After the removal of releasable sutures, the filtering bleb was prominent over the superior limbus for 3 consecutive clock hours with an IOP of about 4–5 mmHg. The Seidel test result was negative, and the anterior chamber depth was moderate to deep. The BCVA of the right eye decreased to 20/100, and optical coherence tomography revealed macular edema. We injected sodium hyaluronate (Healon, Abbott Medical Optics, Santa Ana, CA, USA) into the anterior chamber 2 months after the operation, and repeated the same procedure 4 days later. After each injection, the IOP spiked up to 50 mmHg, and an intravenous infusion of mannitol was required. Sodium hyaluronate was found migrating into the bleb on post-injection day 1. Then we decided to revise the bleb by suturing the scleral flap at two sides. The IOP of the right eye returned to 10 mmHg 4 days after the revision surgery. The BCVA of the right eye recovered to 20/20 6 months after the revision. Optical coherence tomography also showed recovery from macular edema. One IOP-lowering agent (1% brinzolamide ophthalmic suspension) was required for IOP control after bleb revision. Early revision of the scleral flap may resolve hypotony and associated serious complications.
  698 58 1
A lack of ongoing diabetes is an important factor in preserving eyes from late or suboptimally treated endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess
Shwu-Jiuan Sheu, Yao-Shen Chen, Huey-Shyan Lin, Shih-Lin Chen, Pei-Jan Tsai
January-March 2015, 5(1):23-27
DOI:10.1016/j.tjo.2014.10.007  PMID:29018660
Purpose: The purpose of this study is to identify the possible factors for preserving the eyes after late or suboptimally treated endogenous endophthalmitis secondary to Klebsiella pneumoniae (KP) liver abscess. Methods: A retrospective chart review was conducted for patients admitted with KP liver abscess from January 1991 to June 2012. Results: Six hundred and ninety-three patients with KP liver abscess were recorded, in which endoph-thalmitis was identified in 53 cases (65 eyes, 8.29%). Diabetes was significantly associated with the development of endophthalmitis (p = 0.014). Eleven eyes received their last ocular treatment ≥10 days and final vision ≥ counting fingers, and were defined as benign type KP endophthalmitis. The absence of diabetes was the only consistent candidate factor for benign type KP endophthalmitis. Conclusion: A lack of ongoing diabetes is an important factor in preserving eyes with late or suboptimally treated endogenous endophthalmitis second to KP liver abscess.
  677 49 2
Spectral-domain optical coherence tomography findings of subinternal limiting membrane hemorrhage in the macula before and after Nd:YAG laser treatment
Pei-Yao Chang, Jia-Kang Wang, Chang-Hao Yang
January-March 2015, 5(1):33-35
DOI:10.1016/j.tjo.2013.12.007  PMID:29018662
We reported the spectral-domain optical coherence tomography (SD-OCT) findings of a subinternal limiting membrane hemorrhage in the macula in one patient with Valsalva retinopathy and in one patient with macroaneurysm before and after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser membranotomy. Within 1 week, the Nd:YAG laser treatment facilitated rapid absorption of the hemorrhage in both patients. Spectral-domain optical coherence tomography was helpful before laser treatment to evaluate the exact location of the blood and after laser treatment to confirm the amount and location of residual hemorrhage, which was hard to confirm by only indirect ophthalmoscopy.
  655 39 1