ABSTRACT
PURPOSE: To report three cases of rituximab treatment in refractory orbital inflammatory disease. CASE SUMMARY: Rituximab treatment was performed in three patients (thyroid-associated ophthalmopathy, orbital myositis, and idiopathic sclerosing inflammation) unresponsive to corticosteroid and radiotherapy. One cycle consisted of intravenous infusion of 1000 mg of rituximab, twice at a two-week interval. The patient with thyroid-associated ophthalmopathy exhibited clinical improvement in visual acuity, color vision, visual evoked potential, and visual field after one cycle of rituximab treatment. The patient with orbital myositis improved showed diplopia with a decrease in the size of the extraocular muscle after two cycles of treatment. The patient with idiopathic sclerosing inflammation showed improvements in visual acuity and visual field defect after one cycle of therapy. There were no severe infections or hematologic adverse effects including neutropenia, or decreased immunoglobulin during the follow-up period. CONCLUSIONS: Treatment with rituximab appears to offer another therapeutic option in patients unresponsive to corticosteroid or radiotherapy.
Subject(s)
Humans , Antibodies, Monoclonal, Murine-Derived , Color Vision , Diplopia , Evoked Potentials, Visual , Follow-Up Studies , Graves Ophthalmopathy , Immunoglobulins , Inflammation , Infusions, Intravenous , Muscles , Neutropenia , Orbit , Orbital Myositis , Visual Acuity , Visual Fields , RituximabABSTRACT
PURPOSE: To report a patient with isolated congenital absence of the right inferior rectus muscle. To our knowledge, this is the first case reported in Korea. METHODS: A 6-year-old girl presented with an anomalous head posture of 15 degrees head tilt. She had 45delta right hypertropia, 15delta A-pattern exotropia and a marked underaction of the right inferior rectus. At the time of the surgery, forced duction test of the right eye showed no limitation and the inferior rectus muscle was found to be absent. Inferior transposition of the horizontal rectus muscles was more approximated to each other than that described in the classic Knapp operation. This was carried out while the right medial rectus muscle was simultaneously resected 2mm for correction of the exotropia. RESULTS There was significant improvement in infraduction at 6 months postoperative with only a residual 6delta exotropia in primary position. CONCLUSIONS: Absence of the inferior rectus showed hypertropia with A pattern exotropia. It did not bring about contracture of the superior rectus muscle or amblyopia. The outcome of the modified Knapp procedure was satisfactory.
Subject(s)
Child , Female , Humans , Amblyopia , Contracture , Exotropia , Head , Korea , Muscles , Posture , StrabismusABSTRACT
PURPOSE: To report a patient with isolated congenital absence of the right inferior rectus muscle. To our knowledge, this is the first case reported in Korea. METHODS: A 6-year-old girl presented with an anomalous head posture of 15 degrees head tilt. She had 45delta right hypertropia, 15delta A-pattern exotropia and a marked underaction of the right inferior rectus. At the time of the surgery, forced duction test of the right eye showed no limitation and the inferior rectus muscle was found to be absent. Inferior transposition of the horizontal rectus muscles was more approximated to each other than that described in the classic Knapp operation. This was carried out while the right medial rectus muscle was simultaneously resected 2mm for correction of the exotropia. RESULTS There was significant improvement in infraduction at 6 months postoperative with only a residual 6delta exotropia in primary position. CONCLUSIONS: Absence of the inferior rectus showed hypertropia with A pattern exotropia. It did not bring about contracture of the superior rectus muscle or amblyopia. The outcome of the modified Knapp procedure was satisfactory.
Subject(s)
Child , Female , Humans , Amblyopia , Contracture , Exotropia , Head , Korea , Muscles , Posture , StrabismusABSTRACT
PURPOSE: To determine the degree of control-grade of exotropia and related clinical factors in patients diagnosed with intermittent exotropia. METHODS: One hundred seventy-six patients with a diagnosis of intermittent exotropia were evaluated for control of their deviation. The relationship to age at onset and diagnosis, time interval between the onset and diagnosis, refractive error, visual acuity, near stereopsis, angle of deviation, type of exotropia, accompanied hypertropia, oblique overaction and AV pattern were investigated. RESULTS: Mean control grade is 2.76+/-1.56 point and 114 (65%) were within range of grades from excellent to fair. Poor control of exotropia was significantly correlated with poor near stereopsis (p=0.000), long time interval (p=0.033), binocular amblyopia (p=0.000), large angle of exodeviation (p=0.028), convergence insufficiency type (p=0.017), accompanied hypertropia (p=0.008), AV pattern (p=0.003), and oblique overaction (p=0.000). Among these factors, the influences of stereopsis, hypertropia, oblique overaction, convergence insufficiency type were statistically significant when multiple linear regression analysis was performed (p=0.000, 0.026, 0.044, 0.011 respectively). CONCLUSIONS: The factors of near stereopsis, accompanied hypertropia, oblique overaction and convergence insufficiency type correlated significantly with control of exotropia which may interfere with fusion and contribute to the prognosis of intermittent exotropia.