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Purpose: To report two cases of paraproteinemic keratopathy (PK).Case summary: A 57-year-old man visited the ophthalmology clinic complaining of decreased visual acuity since 1 year earlier. White crystalline deposits were observed on both corneas and the best corrected visual acuity (BCVA) of both eyes was 1.0. After 3 months, the BCVA decreased to 0.8 in the right and 0.6 in the left. Increased corneal deposits were observed. To rule out PK, his medical records were checked. The patient had been diagnosed with lymphoplasmacytic lymphoma 3 years earlier. Diagnosing PK, the patient was referred back to the Hemato-Oncology department. After 3 months of chemotherapy, the corneal deposits decreased and BCVA returned to 1.0. A 69-year-old woman presented complaining of decreased visual acuity for 2 years. The uncorrected visual acuity (UCVA) was 0.4 in the right and finger count at 30 cm in the left. Brown deposits were observed on both corneas and lenses. The serum copper level was elevated. She was referred to the internal medicine department and diagnosed with multiple myeloma. After treatment, the laboratory results returned to normal, but the UCVA decreased to hand motion in the left. A left white cataract was noted and cataract surgery was performed. 1 month postoperatively, the BCVA was 0.9, with no change in the corneal deposits.Conclusions: When there are corneal deposits, we should consider PK in the differential diagnosis. In such cases, systemic treatment is the first line. Therefore, diagnosing and referring PK patients to the internal medicine department is crucial.

Orthokeratology adopts reverse geometry rigid gas-permeable contact lenses to alter the corneal shape and hence refractive power. The effect is transient; therefore, the users need to wear the orthokeratology lenses during night time while asleep, so that they can avoid wearing glasses during daytime. The compressive forces of the reverse geometry rigid lenses may disrupt the corneal epithelium and extended overnight wear may potentiate various side effects, such as lens-corneal binding, corneal staining, microbial keratitis, chronic allergic conjunctivitis and lens decentration. In this article, we conducted a systemic review to summarize the major complications associated with orthokeratology lens use and solutions.

Purpose We report the clinical outcomes of retinal capillary hemangioma (RCH) after the application of various treatments. Methods We performed a retrospective chart analysis of eight eyes treated for RCH between August 2009 and January 2018. During the follow-up period, the status and progression of the RCHs were checked by fundus photography, fluorescein angiography, and optical coherence tomography, and additional treatments were applied when necessary. Results Three of the five patients had bilateral RCH, and two had unilateral RCH. Six eyes received laser photocoagulation; two eyes received cryotherapy, and one eye received intravitreal Avastin injection. Three eyes each had intravitreal triamcinolone injection, subtenon triamcinolone injection, and intravitreal dexamethasone injection to control inflammation. Also, two patients took oral prednisolone, and one patient used prednisolone eye drops to control inflammation. Two eyes underwent vitrectomy and scleral buckling due to deterioration of the epiretinal membrane and vitreal traction, respectively. As a result of those treatments, the tumors were stable in five of the eight eyes. However, one eye is now in a pre-phthisis state, and one patient who refused treatment showed progression of the tumor, epiretinal membrane, and traction. Conclusions Because RCHs vary in size, the degree of inflammation, and symptoms, this disorder should be actively treated on a case-by-case basis. Fluorescein angiography should be used periodically to determine recurrence of the tumor or inflammation, and the appropriate treatment should be repeated as necessary. Moreover, regular systemic screening tests for von Hippel-Lindau disease should be performed in RCH patients to ensure that they have no abnormalities other than in the eye.

ImportanceA bayesian network meta-analysis (NMA) can help compare the various types of multifocal and monofocal intraocular lenses (IOLs) used in clinical practice.ObjectiveTo compare outcomes of presbyopia-correcting IOLs frequently recommended in clinical practice through a bayesian NMA based on a systematic review.Data SourcesMedline (PubMed) and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on May 15, 2021, from inception.Study SelectionBased on the research question, randomized clinical trials assessing multifocal IOLs in patients who underwent bilateral cataract extraction were searched. Nonrandomized studies, studies in patients with unilateral or contralateral cataract extractions, duplicated studies, conference abstracts, and nonpeer-reviewed articles were excluded.Data Extraction and SynthesisDescriptive statistics and outcomes were extracted. The NMA was conducted to compare different types of IOLs. The mean differences for continuous variables, odds ratios for binary variables, 95% credible intervals (CrIs), and ranks of interventions were estimated.Main Outcomes and MeasuresThe outcomes examined included binocular visual acuities by distance and optical quality, including glare, halos, and spectacle independence.ResultsThis NMA included 27 studies comprising 2605 patients. For uncorrected near visual acuity, trifocal IOLs (mean difference, −0.32 [95% CrI, −0.46 to −0.19]) and old bifocal diffractive IOLs (mean difference, −0.33 [95% CrI, −0.50 to −0.14]) afforded better visual acuity than monofocal IOLs. Regarding uncorrected intermediate visual acuity, extended depth-of-focus IOLs provided better visual acuity than monofocal IOLs. However, there were no differences between extended depth-of-focus and trifocal diffractive IOLs in pairwise comparisons. For uncorrected distant visual acuity, all multifocal IOLs were comparable with monofocal IOLs. There were no statistical differences between multifocal and monofocal IOLs regarding contrast sensitivity, glare, or halos.Conclusions and RelevanceFor patients considering a multifocal IOL due to presbyopia, bilateral implantation of a trifocal IOL might be an optimal option for patients without compromising distant visual acuity.

Background: We aimed to study the bilateral choroidal thickness (CT) symmetry and difference in uncomplicated pachychoroid subjects using wide-field swept-source optical coherence tomography (SS-OCT). Methods: All subjects underwent a wide-field 16-mm one-line scan using SS-OCT. Bilateral CT was measured at, and compared among, the following 12 points: three points at 900-µm intervals from the nasal optic disc margin (nasal peripapillary area), one point at the subfovea, six points at 900-µm intervals from the fovea to the nasal and temporal areas (macular area), and two peripheral points 5400 and 8100 µm from the fovea (peripheral area). Results: There were no statistically significant differences in CT between the right and left eyes in any area (all p &gt, 0.05), they all showed significant positive correlations (all p &lt, 0.01). However, the correlation coefficients (ρ) were smaller for the nasal peripapillary and peripheral areas compared to the macular area. Conclusions: The CTs in each region were bilaterally symmetrical in subjects with uncomplicated pachychoroid. However, interocular difference in CT increased from the center to the periphery, indicating that the anatomical variation of the nasal peripapillary and peripheral choroid was greater than that of the macula.

PURPOSE To evaluate the changes of axial length (AXL) in eyes with unilateral idiopathic central serous chorioretinopathy (CSC) after resolution of serous retinal detachment. METHODS A total of 31 patients diagnosed with idiopathic unilateral CSC were included in this study. The changes of AXL according to serous retinal detachment were examined. The keratometric value and AXL were measured using partial coherence interferometry. Serous retinal detachment and central macular thickness (CMT) were measured by spectral domain optical coherence tomography. RESULTS The mean age of the 31 CSC patients, including 19 males, was 42.7 years. The AXL was significantly increased from 23.41 to 23.58 mm after resolution of serous retinal detachment (p < 0.001). The CMT was significantly decreased from 413.4 to 226.8 μm after resolution of serous retinal detachment (p < 0.001). The differences in AXL correlated with CMT differences and subretinal fluid height (r = -0.616, p < 0.001 and r = -0.637, p < 0.001, respectively), and the best-corrected visual acuity was significantly different after resolution of serous retinal detachment (p < 0.001). CONCLUSIONS In unilateral idiopathic CSC with serous retinal detachment, a shortened AXL in the acute phase was restored after resolution of serous retinal detachment.

Many studies have reported the effect of hypertension on microcirculation of the retina. Advance of optical coherence tomography angiography (OCTA) allows us more detailed observations of microcirculation of the retina. Therefore, we compared OCTA parameters between chronic hypertension (disease duration of at least 10 yrs; Group A, 45 eyes), relieved hypertensive retinopathy (grade IV HTNR vs. C; 19.4 mm−1vs. 20.1 mm−1, Group B vs. D; 19.8 mm−1vs. 21.8 mm−1, all p vs. C; 0.35 mm2vs. 0.30 mm2, Group B vs. D; 0.36 mm2vs. 0.29 mm2, all p

PURPOSE To determine longitudinal changes of the ganglion cell-inner plexiform layer (GC-IPL) thickness in patients with non-exudative age-related macular degeneration (AMD) without other ophthalmic disease. METHODS Thirty-three eyes of 33 patients with early and intermediate non-exudative AMD (non-exudative AMD group) and 33 normal control eyes were followed for 2 years, and GC-IPL thickness was measured by spectral domain optical coherence tomography at 1-year intervals. The mean rate of GC-IPL reduction was estimated using a linear mixed model and compared between two groups. RESULTS The mean age of patients in the non-exudative AMD group and control groups were 68.82 ± 6.81 years and 67.73 ± 5.87 years, respectively (p = 0.488). The mean GC-IPL thickness at the first visit was 76.61 ± 16.33 μm in the non-exudative AMD and 81.76 ± 3.69 μm in control group (p = 0.387), and these values significantly decreased over time, with an average reduction rate of average GC-IPL -0.86 μm/year in the non-exudative AMD group and -0.32 μm/year in the control group. The difference between two groups was statistically significant (p

Purpose To evaluate the efficacy of triamcinolone-soaked nasal packing in endoscopic dacryocystorhinostomy (EDCR). Methods Patients who underwent EDCR between September 2012 and August 2017 were included. They were assigned to triamcinolone (201 eyes) or control (206 eyes) group based on the order of surgery. Granulation occurrence and outcome were assessed at 3 and 6 months postoperatively, respectively. Results The success rates were 94.3% (overall anatomical success), 90.4% (complete anatomical success), 92.1% (overall functional success), and 76.7% (complete functional success). The overall functional success rate was significantly higher in the triamcinolone group (95.0% vs. 89.3%, p = 0.033). The overall anatomical success rate (96.0% vs. 92.7%, p = 0.149) and complete functional success rate (79.6% vs. 73.8%, p = 0.166) were also higher in the triamcinolone group, but this difference was not statistically significant. Granulation occurred in 62 eyes (15.2%); the incidence was significantly lower in the triamcinolone group (10.0% vs. 20.4%, p = 0.003). Conclusion The authors suggest that use of triamcinolone-soaked nasal packing in EDCR is effective in significantly reducing the incidence of postoperative granulation and epiphora.

PURPOSE We investigated the wide-field choroidal thickness (CT) using swept-source optical coherence tomography (SS-OCT) and compared the characteristics of the choroidal layer between pachychoroid and normochoroid groups. METHODS A total of 120 eyes from 120 normal subjects were included. All subjects were divided into two groups according to the subfoveal CT (≥300 μm, pachychoroid group

Purpose. To evaluate the difference in the repeatability of automated superficial retinal vessel density and foveal avascular zone (FAZ) metrics according to the measurement area of optical coherence tomography angiography (OCTA). Methods. A total of 127 normal eyes from 127 healthy subjects were included. Macular angiography images were acquired from all subjects using the Zeiss Cirrus 5000 with AngioPlex™ OCTA software. Scans of 3 × 3 mm and 6 × 6 mm were each performed twice in a randomly arranged sequence. Vessel density (VD), perfusion density (PD), and FAZ metrics of the superficial capillary plexus were calculated automatically for all scans, and the repeatabilities for both scan patterns were assessed based on intraclass correlation (ICC), coefficient of variation (CV), and coefficient of repeatability (CR) parameters. The average measured values in the two scan patterns were also compared. Results. VD was significantly greater in the 3 × 3 mm scan than in the 6 × 6 mm scan according to all parameters, whereas PD was significantly less in the 3 × 3 mm scan than in the 6 × 6 mm scan. The ICCs for VDs in the central fovea were 0.826 and 0.741 for the 3 × 3 and 6 × 6 mm scans, respectively, and the CVs were 8.00% and 12.75%. For PDs, the ICCs were 0.839 and 0.762 and the CVs were 9.32% and 14.90%. The FAZ metrics in the 3 × 3 mm scan showed good repeatability with an ICC >0.75 and a CV 10%. Conclusions. The 6 × 6 mm macular angiography scans resulted in lower repeatabilities than the 3 × 3 mm scans according to all OCTA parameters, particularly in the central fovea and FAZ metrics. The 3 × 3 mm scan was more suitable than the 6 × 6 mm scan for analyzing macular microvascular density and FAZ metrics.

PURPOSE To determine the changes in peripapillary retinal nerve fiber layer (pRNFL), macular and ganglion cell-inner plexiform layer (GC-IPL) thicknesses in patients with acute anterior uveitis (AAU). METHODS Patients diagnosed with unilateral non-infectious AAU and normal control were enrolled retrospectively. Optical coherence tomography scans were performed during the initial active phase and inactive phase of AAU. Patients were followed for at least 3 months after resolution of inflammatory activity. RESULTS Thirty-seven AAU patients and 40 controls were included. The average RNFL and central macular thickness (CMT) showed significant differences between patients and control groups during active phase (p