No abstract

Multimodal imaging demonstrates choriocapillaris degeneration in eyes with HCQ retinopathy, particularly those with severe retinopathy. The choroidal change was associated with outer retinal toxicity of HCQ.

PurposeThis study was conducted to investigate the depressive symptoms and quality of life (QOL) in patients with age-related macular degeneration (AMD) using data obtained from the Korea National Health and Nutritional Examination Survey V-2 (KNHANES V-2) conducted in 2011.MethodsThis was a population-based, cross-sectional study that selected 329 participants from the fifth KNHANES (2011) who were diagnosed with AMD by an ophthalmologist based on fundus photography. The prevalence of depressive symptoms and the health-related QOL (using EuroQol indices) in this cohort were also estimated. Factors associated with depressive symptoms, including socioeconomic status, QOL indices, and associated chronic diseases, were investigated using multivariate regression models.ResultsDepressive symptoms were observed more frequently in AMD patients than in non-AMD controls (p = 0.013). Among the total 329 AMD participants, 65 (19.8%) had depressive symptoms. There were 16 males (24.6%) and 49 females (75.4%). Upon multivariate analysis, significant factors found to be associated with depressive symptoms were female gender (odds ratio [OR], 2.082; 95% confidence interval [CI], 1.001 to 4.330), being in the “dependent” group for activities of daily living (OR, 4.638; 95% CI, 2.061 to 10.435), and having “some problems” in the “anxiety-depression” dimension of the EQ-5D (OR, 7.704; 95% CI, 1.890 to 31.408).ConclusionsFemale gender and being dependent on others for activities of daily living increased the association of depressive symptoms in this cohort of AMD participants. Screening for depressive symptoms in East Asian AMD patients with these characteristics should be an important component of their care.

PurposeTo compare repeatability between SS-OCT and SD-OCT for measurement of macular, macular retinal nerve fiber (mRNFL), and ganglion cell-inner plexiform layer (GC-IPL) thickness in various retinal diseases.MethodsOne hundred and fourteen eyes of 114 subjects were investigated. Seventy-eight eyes with retinal disease and 36 normal eyes underwent two consecutive measurements of macular, mRNFL, and GC-IPL thickness using SS-OCT and SD-OCT. The data were obtained using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. The eyes with retinal diseases were divided into three subgroups according to central macular thickness (CMT) for analysis. The intraclass correlation coefficient (ICC) was calculated to determine the repeatability of OCT device.ResultsIn normal eyes, both OCT devices showed excellent repeatability of macula, mRNFL, and GC-IPL thickness measurements with high ICCs in all ETDRS subfields. In eyes with retinal disease, although SS-OCT showed better repeatability for inner retinal thickness measurements than SD-OCT, the overall ICCs were lower than those in normal eyes. In subgroup analysis, the ICCs in the low CMT group were lower than those in the normal and high CMT groups, particularly when using SD-OCT.ConclusionsBoth OCT devices had comparable repeatability for retinal thickness measurement in normal eyes and eyes with retinal disease. However, the possibility of measurement error should be considered in eyes with a thin and atrophic retina.

Purpose To evaluate the influence of low signal-to-noise ratio (SNR) of axial length measurement, achieved using IOLMaster, on prediction of target refraction. Methods A total of 131 eyes of 131 patients who underwent phacoemulsification with posterior chamber lens implantation were enrolled. Preoperative axial length measurements were performed with the IOLMaster 500 (Carl Zeiss Meditec, Germany); preoperative SNR values were used to divide the eyes into three groups (Group 1; SNR <10, Group 2; 10 ≤ SNR <50, Group 3; 50 ≤ SNR <100). One month and 6 months after cataract surgery, the manifest refraction spherical equivalents (MRSE) were measured. The mean numeric errors (MNE), the mean of the difference between postoperative MRSE, and preoperative target refraction, using the various intraocular lens (IOL) formulas, were calculated and compared among the three groups. Results One month after cataract surgery, postoperative MRSE was more hyperopic than preoperative target refraction, calculated by the Haigis formula in group 1, and by the SRK/T formula in group 2. After 6 months, for all formulas in group 1, there were significantly hyperopic results (approximately 0.35 diopter). Upon comparison of MNE among the three groups, group 1 was statistically significantly different from the other groups by Haigis formula. Conclusions When the SNR values in biometry, using IOLMaster, are <10, careful attention should be given to determining IOL power, as postoperative spherical equivalents are more hyperopic than preoperative target refraction by IOL formula.

Rationale:Surgically induced scleritis is a rare complication following ophthalmologic surgery such as cataract surgery, pterygium excision, strabismus surgery, and retinal detachment repair. Rheumatoid arthritis (RA) is the connective tissue disease most commonly associated with scleritis.Patient concerns:A 70-year-old woman visited our clinic with complaint of visual disturbance, ocular pain, and conjunctival injection in her right eye of 1 month's duration. She had a stable state of rheumatoid factor positive RA and had a history of multiple intravitreal injections placed in the symptomatic right eye due to age-related macular degeneration.Diagnoses:Anterior scleritis induced by multiple intravitreal injections.Interventions:Topical and systemic steroids were administered.Outcomes:Her symptoms and signs were relieved and no significant recurrence has been occurred with the maintenance of low dose oral steroid.Lessons:Surgically induced scleritis can also be induced by not only major surgical trauma but also by relatively minor trauma such as intravitreal injection (especially in patients who have connective tissue disease such as RA).

Rationale:Cases of bilateral acute angle closure have been reported after use of various drugs.Patient concerns:A 52-year-old woman visited the emergency room and complained of acute bilateral ocular pain and decreased vision accompanied by headache, nausea, and vomiting. One day before, she had started a herbal medicine containing Ma-huang for weight loss. On examinations, myopic shift, edematous cornea, increased intraocular pressure, shallow anterior chamber, and thickened choroid on both eyes were observed.Diagnoses:Angle closure glaucoma induced by drug (Ma-huang).Interventions:To promptly quit the offending drug and apply ocular hypotensives and cycloplegics.Outcomes:Her symptoms and signs were relieved after antiglaucoma medications and no significant recurrence has been occurred.Lessons:Physicians prescribing weight loss medications containing Ma-huang must be aware of the potentially sight-threatening adverse effect of bilateral acute angle closure.

In this study, we investigated the patterns of visual field (VF) defects and the diagnostic abilities of VF tests using different strategies in Asian patients with hydroxychloroquine retinopathy. Patients screened for hydroxychloroquine retinopathy using optical coherence tomography, fundus autofluorescence, VF, and/or multifocal electroretinography were included. The VF was performed using the Humphrey 30-2 and/or 10-2 strategy, and 2,107 eyes of 1,078 patients with reliable results, including 136 eyes of 68 patients with hydroxychloroquine retinopathy, were analyzed. The characteristics of VF findings were evaluated and the sensitivity and specificity were compared between the 30-2 and 10-2 tests in subgroups of retinopathy severity and pattern. The most common VF defect pattern was partial- or full-ring scotoma in both the 10-2 and 30-2 tests. Among the eyes with hydroxychloroquine retinopathy that underwent both tests, 14.2% showed a disparity between the two tests, almost all at the early stage. In overall and early pericentral retinopathy, the sensitivity of the 30-2 test was significantly higher than that of the 10-2 test (95.7% vs. 77.1% and 90.6% vs. 53.1%, respectively; P < 0.05). However, the specificity of the 10-2 test was significantly higher than that of the 30-2 test (89.6% vs. 84.8%, P < 0.001). Therefore, the pattern of retinopathy should be carefully considered when choosing a VF strategy for better detection of hydroxychloroquine retinopathy.