Ophthalmic Examinations in Premature Infants at 3 Years of Age

The prevalence of myopia, strabismus and amblyopia in premature children is higher than in the full-term population.And the higher incidence of ophthalmic abnormalities was found in the group with retinopathy of prematurity. The authors determined the prevalence of ophthalmic abnormalities in 31 premature children without retinopathy of prematurity compared with 31 full-term children.The children were examined when they were 3 years of age from 1993 to 1996. Uncorrected visual acuity of 0.6 or better was noted in 27(43.55%)eyes of the premature children and 35(56.45%)eyes of the full-term children. A total of 17(27.42%)eyes of preterm and 8(12.9%)eyes of full-term children had myopic refractive error(0.25 diopters or greater). And 6(9.68%)eyes of preterm and 11(17.74%)eyes of full-term children had hyperopic refractive error(2.0 diopters or greater). The astigmatism(1.0 diopter or greater)was found in 21(33.87%)eyes in preterm as compared with 10(16.13%)eyes in full-term children. Binocularity was evaluated from Titmus and TNO stereo test. 15(48.4%), 12(38.7%)premature children and 25(80.6%), 23(74.2%)fullterm children passed the Titmus 200 seconds of arc and TNO 240 seconds of arc each. Strabismus was not found in full-term children and 4(6.45%)of premature group. Premature infants without retinopathy of prematurity had higher rates of ocular abnormalities than full-term children. The authors conclude that visual development of premature children should be carefully examined including visual acuity, refractive errors, strabismus etc.

Refractive States of 3~4 Year Olds that Underwent Cryotherapy in ROP

The previous researches proved that the incidence of myopia in cryotreated retinopathy of prematurity[ROP]eyes is higher than that of non-treated ROP eyes. The authors compared refractive states, anterior-posterior axial length and other contributing factors of treated eyes with those of nontreated eyes at the same age group between 3~4 years old. In the cases of cryotreated group, the mean refractive error was -3.48 +/-4.02D. Among 42 treated eyes, 30 eyes became myopic[71.4%]. The mean axial length was 22.46 +/-1.43mm. The mean length of posterior segment was 15.53 +/-1.33mm. In contrast, the mean refractive error was 1.09 +/-1.04D in non-cryotreated group. Three eyes among 42 untreated eyes developed myopia [7.1%]. The mean axial length was 21.02 +/-1.17 mm. The mean length of posterior segment is 14.09 +/-0.97mm. We concluded that myopia could be developed in cryotreated ROP eyes by the elongation of eyeball, specifically of posterior segment.

A Case of Stickler`s Syndrome

Stickler`s syndrome is a progressive, connective tissue disease which has an autosomal dominant trait with variable penetrance. Ocular changes include vitreoretinal degenera- tion, retinal pigmentary changes, retinal detachment, chori- oretinal atrophy, cataract and high myopia. Systemically, characteristic facial appearances, musculoskeletal abnormal- ities and hearing loss may be associated. We experienced a sporadic case of Stickler`s syndrome in a neonate and report with a review of the literatures.

Normal values of Focal Electroretinograms, and the Clinical Applications

Focal cone electroretinograms were performed with 5-degree white flickering stimuli on 100 normal eyes and 50 eyes with known macular diseases. Responses were obtained under direct visualization of the fundus with hand-held stimulator-ophthalmoscope (FSC-500) produced by LKC Technologies. Mean foveal cone amplitude for 100 normal eyes was 449.6 nV and mean implicit time was 34.8 msec, and ninty five percent of normal eyes had amplitudes greater than 320 nV, and implicit time less than 48.5 msec. There was a statistically significant inverse correlation between amplitude from fovea and age (r=-0.93, p< 0.05). In eyes with known maculopathy, mean foveal cone amplitude was well correlated with visual acuity. Over ninty percent (29/32) of eyes with visual acuity of 0.5 or poorer showed significant reduction in amplitude, even after correcting aging effect. We suggest that the focal electroretinogram is a sensitive and useful test for detecting macular abnormalities.

The Effect of Cryotherapy and Laser Photocoagulation for the Retinopathy of Prematurity

It has been generally accepted that cryotherapy is a effective therapy in structural outcome in management of threshold retinopathy of prematurity. Despited of this structural success, several potential complications have been termed ocular damage. The purpose of this study is to determine whether diode laser photocoagulation, which has fewer adverse effect and is easier to administe, is as effective as cryotherapy in treatment of prethreshold and threshold retinophthy of prematurity. Twenty-one eyes received diode laser retinal photocoagulation, ranging from 1090 to 1750 g birth weight, and sixty-two eyes received cryotherapy, from 1000 to 1680 g birth weight. The laser-treated eyes had 14.3% unfavorable outcome, and the eyes threated with cryotherapy is as effective as cryotherapy in the result suggests that diode laser therapy is as effective as cryotherapy in the treatment of prethreshold and threshold retinopathy of prematurity. Our study, however, showed that posterior retinopathy of prematurity in zone I was more aggressive than retinopathy of prematurity in zone II and had 42% unfavorable outcome. This result suggests that posterior retinopathy of prematurity requires a careful follow-up examination and and earlier surgical intervention than threshold retinopathy of prematurity.

Clinical Study for Anatomical Reattachment and Visual Outcome in Rhegmatogenous Retinal Detachment Treated with Scleral Buckling

We analyzed a total of 41 eyes with rhegmatogenous retinal detachment treated with scleral buckling to evaluate factors elated to anatomical and functional success rate. 22 patients (55 %) were wemen. The most common age group was third decade(27.5%). Among the associated ocular findings, the most common finding was high-degree myopia (14 eyes, 34.1%) and the next was lattice degeneration. The most common postoperative complication was temporary elevation of intraocular pressure (14 eyes, 34.1 %). The overall anatomical success rate was 87.8 % and functional success rate was 68.3%. Important factors related to anatomical and functional success were duration of retinal detachment(less than 1 month), location of tears(at or anterior to the equator) and the difference of intraocular pressure between affected and unaffected eyes(less than 10 mmHg). The macular status was highly related to the functional success. The sex, age , preoperative visual acutiy, preoperative refractive error and surgical method had no statistically significant relationship with success rate.

Analysis of Ophthalmic Examination for 4 and 5 Year Old Children Referred from Previous Vision Screening

We performed comprehensive ophthalmic examinations for 127 children at 4 and 5-year-old referred from primary(for 3315 subjects) and secondary(for 1441 subjects) vision screening. Although it may be duplicated, the 112 children(3.4%) had ametropic eyes, 49(1.5%) amblyopia, and 8(0.2%) strabismus. The mixed astigmatism took possession of 40% of ametropia, and 93.2% of ametropia had astigmatism on the whole. Among strabismic children, the case of exotropia was equal to that of esotropia by 4. The Titmus and TNO stereoacuity were not adequate to detect amblyopia. The early detection of eye problems for preschool children is important to prevent the permanent visual disability. It is necessary to make institutional devices for preschool vision screening.

Problems of Application to McBride Disability Evaluation in Loss of Visual Effciency Patients

We had carried out a retrospective analysis which consisted of 61 consecutive cases on disability evaluated and estimation of loss of efficiency in this hospital for the last five years. Factors in disability evaluation were decreased visual acuity (27 patients, 44.2%), contracted visual field (5 patients, 8.1%) and disabled ocular motility (15 patients, 24.5%). Estimation errors in disability evaluation occurred in 9 (14.7%) in all cases. The average error rate was 10.2%. The causes were confusion of efficiency with loss of efficiency, conversion deficiency of 75% visual efficiency in pseudophakic eye and estimation errors in diplopia field test. Beforehead estimation cases in disability evaluation were 9 cases (4.7%). The case which needed request of calculation of medical fee after this were 19 cases (31.3%). The incidence of malingering were observed in 11 patients (18.0%) and the major factor of malingering was decreased visual acuity (8 patients, 72.7%). In conclusion, with the use of the estimation of loss of efficiency, we presented many problems such as estimation errors, beforehead estimation cases in disability evaluation, maligerings, request of calculation of medicalfee after this, and etc. Therefore, in accord with the actual condition, we request the establishment of standardization, methods, articles of estimation.

Ocular Manifestations in Patients with Chronic Renal Failure

Many ocular findings have been shown in patients with chronic renal failure. There has been no systematic study on ocular manifestations in patients with chronic renal failure. The medical records of 349 patients with chronic renal failure, who were referred to ohthalmologic department, were reviewed. Of 349 patients, 109 were renal transplanted patients, 118 were hemodialysis, and 122 were CAPD. Sixty-five % were male, 35% were female, and their mean age was 42 years old. For renal transplanted patients, 47% had a visual acuity of 1.0 or better, while 6% had worse than finger counting. Nineteen % and 15% of hemodialysis, and 19% and 24% of CAPD patients had a visual acuity of 1.0 or better and worse than finger counting, respectively. Hypertension was the most common associated systemic disease. Primary causes of renal failure were chronic glomerulonephritis(44.4%), diabetic nephropathy(17.2%), hypertensive nephropathy(4.6%), and CRF NOS(29.5%). Hypertensive retinopathy(45.6%) was the most common ocular manifestation of all patients with renal failure. Others were cataract, diabetic retinopathy, ischemic optic neuropathy and retinal detachment. These results suggest that ocular complications are common in patients with chronic renal failure and therefore, close follow up has to be performed after renal transplantation and during dialysis.

A Vision Screening and Eye Evaluation of Three-year-old Children

The earliest time of adequate ophthalmic examination is about 2 1/2 to 3 years old (verbal child). The authors performed 7 tests in the group of normal children aged at 3 years old. The subjects of study were 44 children, 88 eyes, in which there are no amblyopes and no strabismus, whose corrected visual acuity were 0.6 or better, and whose differences of visual acuity between right and left eyes were two or less lines on Han's chart. The average age is 41.7 months, uncorrected visual acuity mainly ranged from 0.3 to 0.8 on Han's chart, and the average value of refraction is +1.21 +/- 1.917D. The visual acuity and refractive power showed significant correlation (p<0.05). Of 88 eyes which underwent cycloplegic refraction, 47 eyes (53.5%) showed hyperopic refractive error, and 58 eyes (65.9%) had astigmatism. Hyperopic astigmatism and with- the-rule astigmatism were the most common. The average value of the axial length (21.82 +/- 0.82mm) and anterior chamber depth (3.12 +/- 0.25mm) did not show significant difference between male and female 3 year-old child. But, axial length and refractive power showed significant correlation (p<0.05). 32 (72.7%) and 29 (65.9%) children passed the Titmus 200 sec and TNO 240 sec each, and all of the children who had 0.8 or better vision passed Titmus 100 sec and TNO 120 sec each.

Normal Values of Standard Electroretinography, and Change with Age and Sex (I)

Electroretinography has been used clinically for more than 50 years as useful retinal function test. But there has been no uniform recording signals, since various laboratories have employed different technologies and recording condition. Therefore, in 1989, International Society for clinical Electrophysiology of Vision (ISCEV) published Standard for clinical ERG, to ensure that ERG performed simply and uniformly worldwide for clinical and research purpose. We performed this standard ERG to 100 normal subjects whose range of ages were 8-79 years old. We obtained normal values of standard 5 basic response parameter. Additionally, we studied the parameter change according to age and sex. We found significantly decreased amplitude in the b-wave with age (p<0.05), and also obtained decreased rate b-wave amplitude with age. But no relation between b-wave implicit time and change of age was noted. B-wave amplitude found to be higher in women than in men (p<0.05).

A Case of Sjogren-Larsson Syndrome

The Sjogren-Larsson syndrome is genetically determined syndrome with autosomal recessive inheritence and characterized by the three cardinal signs: congenital ichthyosis, spastic di/tetraplegia, and mental retardation. Ocular signs include ectropion, blepharitis, conjunctivitis, keratitis, and macular glistening spot. The authors have experienced a case of Sjogren-Larsson syndrome that showed classical triad and macular glistening spot in a 16 month old boy.

Microphthalmos with Large Cyst and Colobomatous Microphthalmos in the Other Eye

Microphthalmos is a uncommon congenital ocular anomaly and the term is justified in that in all cases the eyes are smaller than normal. Microphthalmos is classified as various forms according to degrees of developmental abnormality. The authors experienced a case of microphthalmos with a large cyst in one eye and colobomatous microphthalmos in the other eye.

The Detection of the Cystoid Macular Edema after Cataract Extraction with Oral Fluorescein Angiography

Cystoid macular edema (CME) is a relatively common cause of temporary or permanent visual impairment after cataract extraction. Fluorescein angiography is indispensable to diagnose the CME. Intravenous fluorescein angiography is asscciated with a high incidene of minor adverse effects but a very low incidence of life-threatening serious reactions. There are no reports of oral fluorescein causing a senous reaction, and minor adverse effects are uncommon. We had Performed the oral fluorescein angiography in 30 consecutive cases (31 eyes) to detect the CME after cataract extraction. Two eyes (6.45%) had definite evidence of CME on the fluorograms. The typical angiogram of CME were obtained at 30 or 40 minutes after they had taken the fluorescein sodium. A dose of 20mg/Kg body weight produced good quality angiograms in 71% of the patients. There was no serious reaction but a mild pruritus was noted in one patient(3.3%). Therefore, we have concluded that the oral fluorescem agniography is very useful method because the oral fluorogram may avoid the adverse effect that could occur in intravenous fluorescein injection and be comparable in quality with those produced by intrvenous fluorescein.

Biopsy Findings of Conjunotival Goblet Cell Densities Around The Pterygium

The goblet cell population of the conjunctiva reflects the degree of the differentiation or maturation of the conjunctival epithelium, which in turn reflects the overall health of the ocular surface. The authors observed the conjunctival goblet cell counts in the 25 eyes with pterygium stained with Periodic acid-Schiff(PAS) and Hematoxylin-Eosinophil(H-E) stain for the evaluation of the conjunctival health state in the presence of pterygium, and compared conjunctival goblet celli counts in the eyes with pterygium with that in the normal 20 eyes. The distribution of conjunctival goblet cells was evaluated in observing the bulbar conjunctival cell counts at 12, 3, 6, 9 o'clock site in enucleated eyes due to phthisis bulbi. There was significant decrease(P<0.01) in the conjunctival goblet cell counts in the eye with pterygium, and was many difference in the individual cases. Mean goblet cell counts in the normal subjects was 6.6/mm. The number of goblet cells was highest in the nasal side, followed by inferior, superior, and temporal side.

Two Cases of Goldenhar's Syndrome

Goldenhar's syndrome is a rare congenital disorder consisting of epibulbar dermoids or lipodermoids, auricular appendages and skeletal anomalies. There are anomalies resulting from faulty development of the first and second branchial arches and the first branchial cleft. We have seen a female infant with coloboma of left upper eyelid, symblepharon, epibulbar dermoid and a young male with epibulbar dermoid and lipodermoid.

A Review of Color Deficiency Among the Industrial Workers

The authors surveyed on 154 color deficient workers among 6,023 industrial workers that had undergone a physical examination at Soon Chun Hyang Gumi Hospital but had good visual acuity and no retinal disease. They were examined with 3 kinds of test including AO pseudoisochromatic plate, Ishihara's plate and Han's color vision test. So, results were obtained as follow; 1. AO pseudoisochromatic plate was used only as distinguishable method of existence of color defect. 2. With the Ishihara plate, frequencies as to types of defect were protanopia 19(12.3%), deuteranopia 71(46.1%), protanomaly and deuteranomaly 15(9.7%), and unclassified 48(31.2%). The most frequent type of color defect was deuteranopia. 3. With the Hahn's color vision test, frequencies as to types of defect were protan 33(21.4%), deutan 72(46.7%), and unclassified 48(31.2%). Also in this test, deutan was the most frequent type. 4. Extent of color defect by the Hahn's test was mild(Grade I) 38.3%, medium(Grade II) 23.4%, and strong(Grade III) 38.3%.

A Case of the Aberrant Retinal Vessels

The cilio-retinal artery appears on the temporal side of the optic disc margin and is concerned with the supply of the portion between the optic disc and the macula. So, the cilio-retinal artery preserves vision when occlusion of the central retinal artery occurs. The aberrant macular artery is very rare and in most of the cases have been derived from the inferior temporal arterial or venous trunks. When this artery is appeared, the corrected vision is normal but sometimes diminished. The authors have experienced two aberrant retinal vessels of a large cilio-retinal artery and aberrant macular artery combined with the Stargardt's maculopathies. It was reviewed clinically with the literature.

A Case of Modified Jensen Procedure in 6th Nerve Palsy

Because of the long intracranial course, the 6th nerve is vulnerable to increased intracranial pressure, trauma to the cranial floor, meningeal edema, inflammation in the base of the skull, and any displacement of the brain stem. The authors had experienced a case of abducens nerve palsy resulting non-concomittent esotropia and lateral gaze palsy due to brain trauma by traffic accident. We had performed modified Jensen procedure that had good result. That procedure is presented to aid in preserving the anterior segment blood supply. The anterior ciliary artery in the lateral rectus is not included in the union. The case report is reviewed with the pertinent literature.

Congenital Blepbaroptosis

The surgical correct1on of blepharoptosis is accomplished by utilizing certain materials, the levator, the frontalis or the superior rectus muscle. The perfect postoperative results are complete cover of the eye on lid closure, adequate mobility when blinking, normal lid fold and no diplopia. The authors obtained good results in two children of congenital ptosis by attaching medial one third of superior rectus muscle to lid margin which was reported by Motais in 1897. The operation which use the superior rectus muscle is not favored recently because of complicationals such as partial corneal exposure, vertical diplopia, difficulty in blinking, and partial obliteration of the upper conjunctival fornix. But, the results of these simple physiologic proceures for binocular paralytic ptosis were remarkable without any complications as the aboves for 3 months of follow up check.