We report a case of ophthalmic artery obstruction combined with brain infarction following periocular autologous fat injection. The patient, a 44-year-old woman, visited our hospital for decreased visual acuity in her left eye and dysarthria one hour after receiving an autologous fat injection in the periocular area. Her best corrected visual acuity for the concerned eye was no light perception. Also, a relative afferent pupillary defect was detected in this eye. The left fundus exhibited widespread retinal whitening with visible emboli in several retinal arterioles. Diffusion-weighted magnetic resonance imaging of the brain showed a hyperintense lesion at the left insular cortex. Therefore, we diagnosed ophthalmic artery obstruction and left middle cerebral artery infarction due to fat emboli. The patient was managed with immediate ocular massage, carbon dioxide, and oxygen therapy. Following treatment, dysarthria improved considerably but there was no improvement in visual acuity.

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Background Enhanced S-cone syndrome is an orphan disease caused by mutations in the NR2E3 gene which result in an increased number of S-cones overpopulating the retina. Although the characteristic onset of enhanced S-cone syndrome can be well-documented by current ophthalmic imaging modalities, techniques such as spectral-domain optical coherence tomography (SD-OCT) and scanning laser ophthalmoscopy (SLO) fail to provide sufficient details regarding the microstructure of photoreceptors in retinal diseases. Adaptive optics (AO) provides a unique opportunity to analyze the effects of genetic mutations on photoreceptors by compensating aberrations of human eyes. Methods Three eyes of three young adults with enhanced Scone syndrome were studied by clinical examination, genetic screening, fundus autofluorescence (FAF) imaging, SD-OCT, and electroretinography (ERG). Cone mosaic imaging was accomplished by an AO-SLO equipped with a dual crystal on silicon spatial light modulator. Qualitative image analyses and genetic findings were investigated in each patient. Results The diagnosis of patients was confirmed by ERG finding. Genetic screening confirmed the presence of two disease-causing mutations in the NR2E3 gene in each study patient, as well as identified a novel mutation (202 A > G, S68G). Fundus photograph, FAF, and SD-OCT found rosette-like lesion within the mid-periphery along the vascular arcades of the retina. In all AO-SLO images of patients, sparse distribution and asymmetric size of cone mosaic pattern were found within central retina. There were regions of dark space between groups of photoreceptors, distinguishable from shadowing and artifacts. Conclusions AO-SLO provided an in-depth window into the retina of live enhanced S-cone syndrome patients beyond the ability of other current imaging modalities. Dark lesions within the central retina in each patient contain structurally dysfunctional cones which account for retinal mosaic disorganization, and may predispose affected areas to other abnormalities such as rosette lesions. AO-SLO can be an efficient diagnostic tool in clinics for examining cellular-level pathologies in various retinal dystrophies.

BACKGROUND AND OBJECTIVE To compare fundus autofluorescence (FAF) imaging via fundus camera (FC) and confocal scanning laser ophthalmoscope (cSLO). PATIENTS AND METHODS FAF images were obtained with a digital FC (530 to 580 nm excitation) and a cSLO (488 nm excitation). Two authors evaluated correlation of autofluorescence pattern, atrophic lesion size, and image quality between the two devices. RESULTS In 120 eyes, the autofluorescence pattern correlated in 86% of lesions. By lesion subtype, correlation rates were 100% in hemorrhage, 97% in geographic atrophy, 82% in flecks, 75% in drusen, 70% in exudates, 67% in pigment epithelial detachment, 50% in fibrous scars, and 33% in macular hole. The mean lesion size in geographic atrophy was 4.57 ± 2.3 mm2 via cSLO and 3.81 ± 1.94 mm2 via FC (P < .0001). Image quality favored cSLO in 71 eyes. CONCLUSION FAF images were highly correlated between the FC and cSLO. Differences between the two devices revealed contrasts. Multiple image capture and confocal optics yielded higher image contrast with the cSLO, although acquisition and exposure time was longer.

Introduction: Recently in South Korea, there are increasing number of young adults undergoing orthokeratology treatment for myopia control. They prefer orthokeratology treatment more than wearing spectacles or having a refractive surgery for several reasons. However, there is little research on the effect of orthokeratology treatment on choroids. Objective: The aim of this study was to analyze the change in choroidal thickness (CT) in the horizontal axis in young myopic adults after orthokeratology treatment. Methods: This was a retrospective research among young myopic patients (−1.0 to −5.0 diopters) aged 19–29 years (n = 36; 23.6 ± 2.5 years). We selected patients who were treated with orthokeratology for 12 months. CT values of the horizontal axis near the fovea before and after orthokeratology treatment were analyzed using optical coherence tomography. The value was measured at the beginning of treatment and at 3, 6, and 12 months after orthokeratology treatment. Three regional areas of choroid on the horizontal plane including fovea were analyzed. Result and Conclusions: In the beginning of orthokeratology treatment, CT of the horizontal axis was 248.9 ± 45.7 μm in the temporal region, 259.9 ± 55.3 μm in the macular region, and 219.2 ± 46.4 μm in the nasal region. Three months after orthokeratology treatment, thickness values of choroids in the 3 divided areas increased significantly (p < 0.05). Mean CT at 6 or 12 months after orthokeratology treatment was greater than before ortho­-keratology treatment. CT increased after 3 months of orthokeratology treatment in each regional area. In young myopic adults, CT in nasal area was thinner than that in foveal or temporal area before treatment. CT recovered to near baseline when it was observed for more than 6 months after orthokeratology treatment.

ImportanceFungal endophthalmitis caused by contaminated medical products is extremely rare; it follows an intractable clinical course with a poor visual prognosis.ObjectiveTo report the epidemiologic and clinical features and treatment outcomes of a nationwide fungal endophthalmitis outbreak after cataract surgery as a result of contaminated viscoelastic agents in South Korea.Design, Setting, and ParticipantsThis was a retrospective case series analysis of clinical data from multiple institutions in South Korea conducted from September 1, 2020, to October 31, 2021. Data were collected through nationwide surveys in May and October 2021 from the 100 members of the Korean Retinal Society. Patients were diagnosed with fungal endophthalmitis resulting from the use of the viscoelastic material sodium hyaluronate (Unial [Unimed Pharmaceutical Inc]). Data were analyzed from November 1, 2021, to May 30, 2022.Main Outcomes and MeasuresThe clinical features and causative species were identified, and treatment outcomes were analyzed for patients who underwent 6 months of follow-up.ResultsThe fungal endophthalmitis outbreak developed between September 1, 2020, and June 30, 2021, and peaked in November 2020. An official investigation by the Korea Disease Control and Prevention Agency confirmed contamination of viscoelastic material. All 281 eyes of 265 patients (mean [SD] age, 65.4 [10.8] years; 153 female individuals [57.7%]) were diagnosed with fungal endophthalmitis, based on clinical examinations and supportive culture results. The mean (SD) time period between cataract surgery and diagnosis was 24.7 (17.3) days. Patients exhibited characteristic clinical features of fungal endophthalmitis, including vitreous opacity (212 of 281 [75.4%]), infiltration into the intraocular lens (143 of 281 [50.9%]), and ciliary infiltration (55 of 281 [19.6%]). Cultures were performed in 260 eyes, and fungal presence was confirmed in 103 eyes (39.6%). Among them, Fusarium species were identified in 89 eyes (86.4%). Among the 228 eyes included in the treatment outcome analysis, the mean (SD) best-corrected visual acuity improved from 0.78 (0.74) logMAR (Snellen equivalent, 20/120 [7.3 lines]) to 0.36 (0.49) logMAR (Snellen equivalent, 20/45 [4.9 lines]) at 6 months. Furthermore, disease remission with no signs of fungal endophthalmitis (or cells in the anterior chamber milder than grade 1) was noted in 214 eyes (93.9%).Conclusions and RelevanceThis was a retrospectively reviewed case series of a fungal endophthalmitis outbreak resulting from contaminated viscoelastic material. Findings of this case series study support the potential benefit of prompt, aggressive surgical intervention that may reduce treatment burden and improve prognosis of fungal endophthalmitis caused by contaminated medical products.

Background To assess diagnostic efficacy of plasma total homocysteine (tHcy) and C-reactive protein (CRP) levels for ocular ischemic syndrome (OIS). Methods In all, 87 patients with retinal vein occlusion (RVO), 955 patients with a stenosis of internal carotid artery (ICA) o90% and 159 patients with a stenosis of ICA 490% were included between 2003 and 2009. A total of 43 patients with a stenosis ICA 490% were diagnosed as OIS. Fasting tHcy, CRP, lipid profiles, creatinine were measured, and diagnostic values of hyperhomocysteinemia or elevated CRP for OIS were evaluated. Result The mean plasma levels of tHcy (18.8 lmol/l) and CRP (1.1 mmol/l) were the highest in patients with OIS among the groups. The prevalences of hyperhomocysteinemia (72%) and elevated CRP (77%) were the highest in OIS among the groups. In patients with stenosis of ICA, the diagnostic sensitivity/specificity for OIS was 70/79% in hyperhomocysteinemia and 73/73% in elevated CRP. The diagnostic sensitivity and specificity for OIS were 53 and 86% in both hyperhomocysteinemia and elevated CRP. The lipid profiles and creatinine levels were similar among the groups. Conclusion Our results suggest that hyperhomocysteinemia and elevated CRP may be associated with the development of OIS. The measurements of tHcy and CRP in blood may help to assist the diagnosis of OIS in a stenosis of ICA.