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  1. Chou HD, Teh WM, Sun MH, Chen KJ
    Eur J Ophthalmol, 2021 Sep;31(5):NP83-NP87.
    PMID: 32460537 DOI: 10.1177/1120672120926855
    INTRODUCTION: The Epstein-Barr virus is a rare causative pathogen identified in the posterior segment. The majority of cases were presented with a serious condition of acute retinal necrosis, and most of these eyes had poor outcomes. The clinical features and effective treatment options for this condition are still unclear.Case description: A 10-year-old boy with leukaemia and receiving immunosuppressive regimen presented with decreasing visual acuity to counting fingers in his left eye for 2 weeks. Fundus examination revealed disc swelling, retinitis, retinal exudates and haemorrhages. Aqueous polymerase chain reaction was positive for Epstein-Barr virus DNA but negative for cytomegalovirus, herpes simplex virus and varicella zoster virus DNA. Systemic acyclovir and intravitreal ganciclovir injection were administered. Seven months later, retinitis resolved with remnant retinal fibrosis, and visual acuity improved to 20/500.

    CONCLUSION: Epstein-Barr virus is rarely identified as a sole pathogen in retinitis. Peripapillary predilection might be another type of presenting feature apart from the more-commonly reported peripheral acute retinal necrosis.

  2. Chou HD, Teh WM, Wu WC, Hwang YS, Chen KJ, Lai CC
    Retina, 2023 Dec 01;43(12):2134-2138.
    PMID: 35512285 DOI: 10.1097/IAE.0000000000003516
    PURPOSE: To report the outcomes of the Peeling and Internal Limiting Membrane Reposition (PAIR) technique in myopic foveoschisis.

    METHODS: A retrospective case series of eyes with myopic foveoschisis that underwent vitrectomy and PAIR. Visual acuity, fundus photographs, and optical coherence tomography measurements were obtained and analyzed. Data are presented as medians (ranges).

    RESULTS: A total of seven eyes underwent PAIR and were followed up for 339 days (188-436 days). No intraoperative complications were noted. One eye exhibited postoperative macular hole formation, but the hole was healed through fluid-gas exchange. At the last follow-up, the visual acuity had improved from 20/66 (20/332-20/40) to 20/40 (20/100-20/25), and the central foveal thickness had decreased from 576 µ m to 269 µ m. A repositioned internal limiting membrane (ILM) was observed in six of the eyes, and inner retinal dimples were noted in only two eyes. However, retinal wrinkles under the repositioned or perifoveal ILM were noted in five eyes.

    CONCLUSION: The PAIR technique relieved traction, restored the ILM, and achieved functional and morphological improvement in eyes with myopic foveoschisis. Limited occurrence of inner retinal dimples and retinal thinning was noted, but retinal wrinkles occurred, likely due to ILM contracture.

  3. Lai CC, Wu AL, Chou HD, Teh WM, Chen KJ, Chen YP, et al.
    BMC Ophthalmol, 2020 Mar 21;20(1):116.
    PMID: 32199465 DOI: 10.1186/s12886-020-01393-1
    BACKGROUND: To evaluate the feasibility of a surgical technique using a sub-perfluoro-n-octane (PFO) injection of ocular viscoelastic device (OVD) to stabilize inverted internal limiting membrane (ILM) flap for the treatment of macular hole retinal detachment (MHRD).

    METHODS: This study was a retrospective, consecutive, interventional case series. Patients who underwent MHRD surgery with sub-PFO injection of OVD to stabilize inverted ILM flap onto the macular hole (MH) were reviewed. The color fundus and optical coherence tomography (OCT) images were collected and evaluated. The best-corrected visual acuity (BCVA) before and after surgery were compared as the functional outcome.

    RESULTS: The study included 8 eyes of 8 consecutive patients (mean age: 61.8 ± 7.1 years; mean follow-up period: 9.0 ± 2.5 months). All eyes (100%) achieved successful MH closure; 7 eyes (87.5%) demonstrated complete retinal reattachment, and 1 eye (12.5%) had minimal residual subretinal fluid parafoveally. Of the 8 patients, 7 patients (87.5%) had achieved improvement in BCVA after the primary surgery, whereas 1 eye remained stable. The average BCVA before and after the surgery at the last visit improved from 20/843 (1.63 ± 0.48 logMAR) to 20/200 (1.00 ± 0.39 logMAR) (P = 0.016). Anatomically, near-normal foveal contour was noted in five (62.5%) eyes at the final follow-up.

    CONCLUSIONS: The use of sub-PFO injection of OVD in MHRD surgery could stabilize inverted ILM flaps, achieve good anatomical results and improve postoperative BCVA.

  4. Kang EY, Chong YJ, Chen KJ, Chou HD, Liu L, Hwang YS, et al.
    Graefes Arch Clin Exp Ophthalmol, 2024 Aug;262(8):2685-2694.
    PMID: 38507045 DOI: 10.1007/s00417-024-06402-3
    PURPOSE: To evaluate stereopsis in term-born, preterm, and preterm children with and without retinopathy of prematurity (ROP) and its treatment.

    METHODS: The cross-sectional study included 322 children between 3 and 11 years of age born term or preterm, with or without ROP, and with or without treatment for ROP. The ROP treatments were laser therapy, intravitreal injection (IVI) of anti-vascular endothelial growth factor, or their combination. Stereoacuity was measured using the Titmus Stereo Test, and the results among various age groups were analyzed.

    RESULTS: Stereopsis was found to improve with increasing age at testing (P  0.05). No significant differences in stereopsis were identified between children with ROP treated with laser versus with IVI (P > 0.05). From multivariate analysis, younger age at testing (P = 0.001) and younger gestational age (P 

  5. Chou HD, Chong YJ, Teh WM, Chen KJ, Liu L, Chen YP, et al.
    Am J Ophthalmol, 2021 03;223:296-305.
    PMID: 32950511 DOI: 10.1016/j.ajo.2020.09.023
    PURPOSE: To compare the outcomes between using a nasal and a temporal inverted internal limiting membrane (ILM) flap both assisted by a novel technique in repairing a full-thickness macular hole (FTMH).

    DESIGN: Retrospective interventional case series.

    METHODS: Thirty-nine eyes from 39 patients with a FTMH <600 μm were included from a single institution. All patients underwent vitrectomy using a semicircular single-layered ILM inverted flap assisted by a sub-perfluorocarbon liquid injection of ophthalmic viscoelastic device (OVD) technique. Best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography were used to compare outcomes between nasal (n = 19) and temporal (n = 20) groups.

    RESULTS: At 6 months postoperatively, all FTMHs closed and BCVA were significantly improved. Overall, 36 eyes (92%) achieved U-shaped closure, and ellipsoid zone restoration was noted in 24 eyes (62%). An ILM flap was present in 29 eyes (74%) and 86% remained single-layered. There were significantly more deep inner retinal dimples in the temporal group (35%) compared with 5% in the nasal group (P = .04), but these were unrelated to BCVA. Significant retinal thinning in the temporal outer sub-field was noted in the temporal group and was negatively correlated with BCVA (rho [ρ]: - .53; P = .03). No significant postoperative retinal displacement was noted in either group.

    CONCLUSIONS: The technique of using sub-perfluorocarbon liquid injection of OVD secured single-layered flaps intraoperatively and postoperatively. Both the nasal and temporal inverted ILM flaps repaired FTMH and improved visual acuity. However, both temporal macular thinning and deep inner retinal dimples were significantly greater in the temporal group.

  6. Wu PY, Fung AT, Dave VP, Iu LPL, Sjahreza E, Chaikitmongkol V, et al.
    Clin Exp Ophthalmol, 2023 Aug;51(6):585-597.
    PMID: 37170410 DOI: 10.1111/ceo.14236
    BACKGROUND: To assess rhegmatogenous retinal detachment (RRD) surgery trends and training among young ophthalmologists (YOs, vitreoretinal fellows or attendings/consultants with ≤10 years of independent practice) and the impact of the COVID-19 pandemic.

    METHODS: An anonymous online survey was completed by 117 YOs in the Asia-Pacific regarding their RRD surgery experiences in 2021-2022.

    RESULTS: To achieve a 90% probability of surgical competency, 91 vitrectomy and 34 scleral buckling (SB) completions during fellowship were needed. In total, 49 (41.9%) YOs had fellowship affected by COVID-19. In the COVID versus pre-COVID era, however, the volume of SB completions per fellowship year decreased significantly (median [IQR] 3.3 [1.5, 9] vs. 13 [6.5, 23]; p 

  7. Chen KJ, Lai CC, Chen HC, Chong YJ, Sun MH, Chen YP, et al.
    Microorganisms, 2021 Apr 24;9(5).
    PMID: 33923356 DOI: 10.3390/microorganisms9050918
    Enterococcus faecalis is known to cause severe acute endophthalmitis and often leads to poor visual outcomes in most ophthalmic infections. This retrospective study is to report the clinical settings, antimicrobial susceptibility patterns, and visual outcome of E. faecalis endophthalmitis at a tertiary referral institution in Taoyuan, Taiwan. E. faecalis endophthalmitis was diagnosed in 37 eyes of 37 patients. Post-cataract surgery was the most common cause (n = 27, 73%), followed by bleb-associated (n = 3, 8%), endogenous (n = 2, 5%), corneal ulcer-related (n = 2, 5%), post-vitrectomy (n = 1, 3%), post-pterygium excision (n = 1, 3%), and trauma (n = 1, 3%). Visual acuities upon presentation ranged from counting fingers to no light perception. Pars plana vitrectomy with intravitreal antibiotics were performed in 23 eyes (76%) as primary or secondary treatment. All isolates (37/37, 100%) were sensitive to vancomycin, penicillin, ampicillin, and teicoplanin. Six of 22 eyes (27%) were resistant to high-level gentamicin (minimum inhibitory concentration > 500 mg/L). Final visual acuities were better than 20/400 in 11 eyes (30%), 5/200 to hand motions in 4 eyes (11%), and light perception to no light perception in 22 eyes (59%). Three eyes were treated with evisceration. Compared with non-cataract subgroups, the post-cataract subgroup showed a significant difference of better visual prognosis (p = 0.016).
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