Measurement of Angle Deviation Using Digital Photographs

PURPOSE: The prism-cover test has been known to be the most accurate method in measuring ocular angle deviation, but the Hirschberg test is used in poorly cooperative patients. To enhance the accuracy of Hirschberg test, we designed a geometric model using digital photographs. METHODS: Fifty normal volunteers were included in this study, who had no ocular disorders. Digital photographs were obtained in the subjects seated 2 m in front of the fixation targets and the camera was set 1 m in front of subjects. In each photograph, the apparent width of the cornea and the distance from the corneal light reflex to the limbus were measured using computer program for calculation of angle deviation. Then we compared the calculated angle deviation with the actual one. RESULTS: Calculated angle deviations with digital image photographs were corresponded to the actual ones from esodeviation 40delta to 10delta (p>0.05), whereas in esodeviation 60delta, 70delta and exodeviation, the larger the deviation angle, the larger the calculated angle composed with the actual one. CONCLUSIONS: Angle deviation measurement using digital photographs appears to be relatively precise and its clinical application will be available in measuring angle deviation of esodeviation.

The Clinical Analysis of Surgical Methods in Intermittent Exotropia

PURPOSE: The outcome after operations for intermittent exotropia were frequently unsatisfactory because of high incidence of postoperative undercorrection, overcorrection or recurrence. The author studied surgical outcome of each operation method in intermittent exotropia. METHODS: The results of surgical treatment in 90 patients with intermittent exotropia were reviewed. The operative procedure were devided into 3 groups-bilateral rectus muscle recessions, unilateral lateral rectus muscle recession and medial rectus muscle resection and medial rectus muscle resection of dominant eye and lateral rectus muscle recession of non-dominant eye. The success of operation was defined as a final alignment of orthotropia, esotropia less than 5 prism diopter or exotropia less than 10 prism diopter in primary position at postoperative 6 months. RESULTS: The method of of operation in medial rectus muscle resection of dominant eye and lateral rectus muscle recession of non-dominant eye lead to higher success rate than other surgical method (96.7%) and the difference with statistically significant (p=0.03). The success rate of bilateral rectus muscle recessions group was 76.6%, and that of unilateral lateral rectus muscle recession and medial rectus muscle resection group was 80.0%. CONCLUSIONS: This result suggested that medial rectus muscle resection of dominant eye and lateral rectus muscle recession of non-dominant eye might be a most effective surgical method for intermittent exotropia.

Angle Kappa Measurement with Slit Lamp Biomicroscope

PURPOSE: There has been a difficulty in measuring angle kappa because special instrument was required. To measure the angle kappa conveniently, we designed a new method using slit lamp biomicroscope. METHODS: We measured the angle kappa in 124 eyes of 62 patients with newly designed method and compared the measurement by new method with those by T-shape ruler or the major amblyoscope. RESULTS: We found the average angle kappa was +3.12 degrees by slit lamp, +2.85 degrees by major amblyoscope and +3.04 degrees by T shape ruler method. There was no significant difference between slit lamp and either major amblyoscope method (p=0.48) or T shape ruler (p=0.18). CONCLUSIONS: The new method of measuring angle kappa using slit lamp biomicroscope seemed to be a convenient and relatively accurate method for measuring of angle kappa and appeared to be beneficial in measurement of ocular deviation.

Phagocytosis and Acid Phosphatase Activity against Candida Albicans in Cultured Rabbit Keratocyte

It has been reported that keratocytes endocytose foreign particles both in vitro and in vivo, suggesting the active participation of keratocytes in corneal wound healing and host defense mechanism. This study was conducted to investigate the phagocytosis of keratocytes against Candida albicans[C.albicans]and the intracellular response after phagocytosis. C.albicans were fixed with glutaraldehyde and then coated with fibronectin. After exposing these C.albicans to the cultured rabbit keratocytes, the phagocytosis of keratocytes against C.albicans was evaluated by light microscope[LM]and transmission electron microscope[TEM], while the intracellular response was evaluated by changes of acid phosphatase activity. Also the study about latex beads was performed at the same time to know even if keratocytes can phagocytose foreign particles, regardless of wheather or not the particles are biodegradable. After Wright staining, phagocytosed latex beads and C.albicans were observed on LM and these were recognized to be surrounded by limiting membranes inside the cytoplasm of keratocytes on TEM. The phagocytic rates of fibronectin-coated were increased to 1.5 times , as compared with that of non-coated group. Acid phosphatase activities were higher in C.albicans-exposed groups than in control[keratocytes cultured without C.albicans or latex beads]during the culture period of 24 hours and they also increased according to culture duration and reached to the plateau after 12 hours. In comparison with non-coated group, fibronectin-coated groups showed a increasing tendency of acid phosphatase activity. These results suggest that keratocytes can phagocytose not only foreign particles but also C.albicans and that fibronectin may act as effective opsonin on phagocytosis, and that keratocytes phagocytosing C.albicans increase acid phosphatase activity to digest engulfed C.albicans when corneal stroma was wounded or inflammed.

The Surgical Results of Medial Rectus Muscle Resection of Dominant Eye and Lateral Rectus Muscle Recession of Non-dominant Eye in Intermittent Exotropia

Intermittent Exotropia has been treated by various surgical methods such as bilateral medial rectus resection, lateral rectus recession and medial rectus resection of deviating eye, and bilateral lateral rectus recession. However, the outcomes of such operations are unsatisfactory because of high incidence of postoperative undercorrection and overcorrection. Authors have performed a surgical method which is the medial rectus muscle resection of dominant eye and lateral rectus muscle recession of non-dominant eye in 68 patients. Authors considered the outcome successful if patients achieve deviation between 10 PD of exophoria and 5 PD of esophoria, good stereopsis, no suppression and no manifest deviation. The success rate was 83.8% (57/68) and there was no overcorrection over 6 months follow-up. As postoperative complications, 5 cases of temporary turning of face and 3 cases of asymmetric palpebral fissure were seen. Therefore, these results suggest that medial rectus resection of dominant eye and lateral rectus recession of non-dominant eye in intermittent exotropia may be an alternative surgical method for intermittent exotropia. However, further studies are necessary to determine the exact surgical amounts and mechanism of this surgical method.

The Study of Normal Visual Fields Using Normal Strategy and Dynamic Strategy in Octopus 101 Automated Perimetery in Korean

Automated static perimeters, which are commonly used for early diagnosis and follow-up of glaucoma patients in Korea, are manufactured overseas, and their basic data were obtained from foreigners and normal values were set to meet them. Therefore, verification of validity of those data should precede their application to Koreans. We compared the mean normal values of standard indices of OCTOPUS 101 automated static perimeter with the values obtained from 140 eyes of 70 healthy Koreans using normal strategy(NS)and dynamic strategy(DS). Mean navlues of mean defect(MD), loss variance(LV), corrected loss variance(CLV), and short-term fluctuation(SF)were: 2.84+/-0.85dB, 2.15+/-0.54dB, 1.22+/-0.42dB, 1.43+/-0.22dBwith NS, and 2.05+/-0.81dB, 1.98 +/-0.58dB, 0.97+/-0.49dB, 1.43+/-0.24dB, repectively with DS. With NS, 114 of 140 eyes (81. 4%)were out of the normal range of MD. With DS, 67 of 140 eyes(47. 9%)were out of normal range of MD, and 2 of 140 eyes(1. 4%)were out of the normal range of SF. Values of the other indices were within normal range of both strategies. Statistical analysis of global indices showed that age was significantly correlated with LV, CLV and SF in NS(P<0.05), and that it was also correlated with LV and CLV in DS(P<0.05). These results suggest that both race and age should be taken into acoount in interpretation of visual fields on automated static perimetry.

2 Cases of Leber's Hereditory Optic Neuropathy Confirmed by Molecular Genetics

Leber's Hereditary Optic Neuropathy(LHON) is a maternally inherited disorders that occurs primarily in young males and is characterized by subacute, sequential, bilateral central visual loss, ultimately, optic atrophy. We report 2 cases of molecularly confirmed LHON which reveal 11778 and 14484 mitochondral DNA mutation, respectively but there is no family history of visual loss. So the diagnosis of LHON deserves to be considered in all crypotogenic cases of acute or subacute optic or chiasmal neuropathy. Late or early age at onset, female gender, and a negative family history should not be dissuasive.

3 Cases of Mobius Syndrome

Mobius syndrome is a rare congenital disease characterized by unilateral or bilateral limitation of abduction and facial palsy due to the 6th and 7th cranial nerve paralysis. In addition, it may be associated with limb anomalies and other cranial nerve paralysis. We experienced three cases of Mobius syndrome characterized by esodeviation associated with bilateral limitation of abduction, bilateral facial atroph, tongue atrophy, congenital amputation of limb, and congenital clubfoot. We performed a large amount of bilateral medial rectus recession and unilateral lateral rectus resection, and obtained cosmetically successful results that orthophoric or less than 10 prism diopter of esotropia in primary postition, but mild limitation of adduction was observed as a complication.

Treatment Effects of MIN GLASSES for Amblyopia and Diplopia

MIN GLASSES is specially manufactured in order to enhance satisfaction of wearer and therefore increase the effectiveness of treatment of an amblyopia and a diplopia. One of the lens is specially grounded and coated to blur vision. Cosmetically, the eye appears to wear regular glasses through the blur lens. We prospectively studied 58 amblyopic children and 10 diplopic adults. Each patient was treated with MIN GLASSES for cosmetic problems. We checked linear visual acuity of pre- and post-treatment. Questionnaires were given to the patients and parents regarding cosmetic satisfaction with treatment. In amblyopic children. 44 patients(75.9%) showed visual acuity improvement of 1.61 +/- 1.50 lines by Han's visual acuity chart. Patient compliance was 87.9%(51 patients) with patient satisfaction based on a questionnaire response. Parents were 87.9%(51 parents) positive response. In diplopic adults, 10 patients(100%) were positive response with satisfaction and demonstrated to be free of symptom of diplopia. MIN GLASSES is effective in high compliance satisfaction of amblyopia and diplopia, and improvement of visual acuity of amblyopia.

A Clinical Study of Cause of Unilateral Exophthalmos

We reviewed the charts of 39 patients had a exophthalmos of 2mm or more than the sound eye by Hertel's exophthalmometer during the last 5 years retrospectively. We attempted to analyze the causes of exophthalmos and the correlation between its causes and degree of exophthalmos, visual acuity, extraocular muscle motion limitation and fundus changes. The most common cause of unilateral exophthalmos was orbital tumor(14/39, 36%), the degree of exophthalmos in orbital tumor showed a tendency to be greater than that of other causes. In orbital tumor patients, extraocular muscle motion limitation and fundus changes also shows a higher tendency than the others. Among unilateral exophthalmos patients, if the degree of exophthalmos, fundus changes and extraocular muscle motion limitation shows moderate or over, it may strongly suggest that the cause is orbital tumor. And also, it is important to cooperate with other departments, especially otorhinolaryngology, in diagnosis and treatment of unilateral exophthalmos patients.

Anterior Transposition of the Inferior Oblique Muscle for Dissociated Vertical Deviation Associated with Inferior Oblique Muscle Overaction

We analyzed the surgical results of 9 eyes in 7 patients who had undergone the anterior transposition of inferior oblique muscle for correction of dissociated vertical deviation(DVD) with inferior oblique overaction from April, 1990 to February, 1992. The follow up periods were at least more than 6 months. In cases of upward deviation angle were less than 16 delta, we have done transposition of the inferior oblique muscle to just temporal insertion of inferior rectus muscle, and in cases of upward deviation angle were more than 16 delta, the inferior oblique muscle was transpositioned to 1mm anterior position of the just temporal insertion of inferior rectus muscle. Average reduction of DVD in method A(5 eyes in 4 patients) was 9.2 delta, average reduction of DVD in method B(4 eyes in 3 patients) was 10.2 delta. As for postoperative complications, mild upgaze limitation was observed in all cases and one case of "V" pattern exotropia and one case of protrusion of lower eyelid were observed at extreme upgaze position. Therefore, anterior transposition of inferior oblique muscle for correction of dissociated vertical deviation(DVD) with inferior oblique overact ion can considered as a good method to remove the postoperative manifest vertical deviation.

A Case of VADS Induced by Immunosuppessants Therapy in Uveitis Patient

VAHS is characterized by viral-like prodromal symptoms, high fever' malaise, hepatosp lenomegaly, pancytopenia. The dignosis is based on a bone marrow biopsy specimen that demonstrates histiocytic hyperplasia with prominent hemophagocytosis of red blood cells, platelets, and nucleated hematopoietic cells Recently, the use of immunosuppressants tends to increase due to increase of autoimmune disease and organ transplantation patients. A large portion of leukemia and organ transplant patients developed VAHS as a secondary viral infection after anticancer drug and immunosuppressants therapy was administered In the field of ophthalmology, VAHS can occur by administration of immunosuppressants in corneal transplantation and autoimmune uveitis patients. Recently we experienced a case of fatal VAHS in a young uveitis patient who had been treated with immunosuppressants. We report this specfic case with literature review bec,lUse of the need for careful observation of general findings occurring during treatment of immunosuppressants such as corticosteroid.

The Clinical Findings in 24 Cases of Orbiital Blow-out Fracture

The materials such as supramid, silastic, silicone and bone graft has been used to repair the orbital blow-out fracture, recently Lyodura(R) has been used. In this report, we analysed the clinical aspects of 24 patients and the usefulness of Lyodura(R) through the operative data in treatment of orbital blow-out fracture was evaluated. We also observed the course of improvement of the diplopia and enophthalmos and evaluated the difference between surgically and nonsurgically treated cases. We evaluated the results through the clinical as peets, radiologic examination and repeated diplopia test after Injury. We divided 24 patients into two groups; one group was treated by surgery (17 patients, 71%), the other group was treated conservatively (7 patients, 29%). The materials that were used to repair the fractured site were Lyodura(R) (15 cases) and resin (2 cases). In all operated cases, there were no significant complications except one case which was reentrapped by accidental pressure to the eye. The subjective diplopia in central field 30 degrees was disappeared within three months in all cases of surgically treated. In conclu sion, it is considered that Lyodura(R) is useful for repairing of blow-out fracture site and we should have to pay more attention to the surgical indication.

4 Cases of Double Elevator Palsy

Double elevator palsy(DEP) is rare paralytic anomaly of ocular motility due to monocular paresis of both elevator muscles. Clinically, DEP is classified into the pure paralytic, restricted and mixed types. The authors describe the clinical experiences of 2 cases of purely paralytic type of DEP and 2 cases of restricted type of DEP treated at Department of Ophthalmology, Pusan Pail, Hospital, Inje Medical College from January 1988 to January 1991. The results were as follows: 1) In the pure paralytic type of DEP, the hypotropia was below 30 prism diopters in the primary position and in the restricted type, greater than 60 prism diopters preoperatively. 2) Preoperatively, the pseudoptosis was shown in 2 cases of purely paralytic type of DEP and it was disappeared postoperatively. The Bell's phenomenon was shown the negative result in 2 cases of restricted type of DEP. 3) For the pure paralytic type, the both vertical and horizontal deviation were corrected completely in primary position by the transposition and recession of the horizontal rectus muscles at one surgery and the limitation of ocular motility remained more and less in the elevation postoperatively but no limitation in the adduction and abduction. For the restricted type, the tenectomy of the inferior rectus muscle corrected about 40 prism diopters of hypotropia without the limitation of the infraduction.

Clinical Analysis of Fringe Acuity by Lotmar Visometer

In cases of opacity of ocular optical media, we can predict postoperative visual outcome vaguely with electroretiongram, Visual evoked potential, Two point discrimination, Blue field entoptoscope, Laser interferometer, Lotmar visometer, Potential acuity meter, Visual display terminal. The Lotmar visometer which is attached to the slit lamp provides simple and inexpensive method to check for fringe acuity. It distinguishes the interval of changeable moire fringes for the measurement of postoperative visual acuity in spite of opacity in ocular media. We compared the preoperative Lotmar visometer fringe acuity with the postoperative final corrected visual acuity in 82 cases of cataract and 15 cases of vitreous opacity at the department of Ophthalmology, Pusan Paik Hospital, Inje University Medical college from January to August 1989. We tested the clinical use of the Lotmar visometer and the results were as follows: 1. The visual acuity when checked by preoperative Lotmar visometer acuity and postoperatIve visual acuity differed in mature cataract and dense vitreous opacity cases. 2. The preoperative Lotmar visometer acuity was within one line of postoperative visual acuity in 47.4% with ECCE only, 34.1% with ECCE and PCL, 53.3% with vitrectomy. 3. The preoperative Lotmar visometer acuity which is included +/-25% of postoperative visual acuity in cases with ECCE only is 58.62%, in cases with ECCE and PCL is 46.15%, in cases with vitrectomy is 66.6% except in mature cataract and dense vitreous opacity. 4. There is a high correlation(r=0.8407)in the cases of vitreous opacity between preoperative Lotmar visometer acuity and postoperative visual acuity except in mature cataract and dense vitreous opacity.

Clinical Observation on Silicone Intubation in Obstruction of lacrimal Drainage System

We report 23 cases of silicone stents intubation for obstruction of lacrimal drainage system in 23 patients with tearing and mucopurulent material discharge from January 1985 to April 1988. The success rate of silicone stents intubation was 47.4% and the most common site of obstruction was nasolacrimal duct(56.5%). 30.3% of patients had complications related to silicone stents, conjunctivitis, punctal erosion etc. With these results, we consider that congenital dacryostenosis, partical and complete nasolacrimal duct obstruction is mainly indicated for silicone stents intubation and better results will be gained if be done with acryocystorhinostomy to prevent complications related to silicone stents.

Leber's Hereditary Optic Neuropathy in Two Brothers of a Family

The Leber's hereditary optic neuropathy, which affects mainly males in the late teens or in the early twenties, is a rare inherited disorder characterized by bilateral rapid loss of central vision. Leber's disease undergoes like optic neuritis in acute stage, but in late stage it results in optic atrophy with severe impairment of visual acuity and absolute central scotoma. Recently the authors have experienced two cases of Leber's optic neuropathy in a family. We observed a patient whose visual acuity of right eye was 0.8 at first examination, but reduced to 0.04 by 2 months after onset in spite of medical treatment, So we described the characteristic clinical findings of Leber's disease with brief review of the literatures.

A Clinical Study of 36 Cases of Retinal Artery Occlusion

Blockage of the retinal artery system may occur in the form of central retinal arterial obstruction, branch retinal arterial obstruction, or combination of aforementioned. It may be related to known pre-existing systemic disease or it may be the initial manifestation of a previous undiagnosed systemic abnormality. The authors evaluatea the clinical course of 35 cases of retinal artery occlusion at Department of Ophthalmology, Pusan Paik Hospital Inje Mgdical College from September, 1979 to June, 1988.

Clinical Evaluation of Visual Conversion Reaction

Visual conversion reaction is characterized by fluctuating visual acuity and tubular fields in the absence of any organic lesion. It is thought that the environmental and psychological factors contribute to the onset of symptom. Twenty-two cases of visual conversion reactions were evaluated clinically and the results were as follows. 1. Visual conversion reaction is more frequent in females and children and low vision is almost always affected bilaterally. 2. Sixteen cases(72.7%) showed tubular and constricted fields inspite of normal CT and electrophysiologic responses. 3. Of the cases, 86.4%(19/22) had improved their reduced visual acuity to over 0.8 after treatment with suggestion, placebo, plano lenses and some kind of psychotheraphy.

A Case of Anterior Ischemic Optic Neuropathy

Anterior ischemic optic neuropathy is the general term of disease causing visual disturbance by stenosis or obstruction of nutritional vessels of optic nerve with or without organic lesion. Patient was a 64 year old man who visited our hospital because of further evaluation of sudden visual loss and loss of lower visual field of left eye. In this case, it is observed that visual acuity of left eye was decreased suddenly and visual field of left eye was constricted on inferior area on 4 month after initial visit, visual acuity and visual field of right eye were affected. On the visual evoked potential, bilateral optic pathway disturbance finding is seen, faulty perfusion of the disc capillary and absence or decrease of the choroidal filling are seen by fluorescein angiography. Thus, anterior ischemic optic neuropathy is suspected by history, visual field, visual evoked potential and fluorescein angiography. This case was presented and a brief review of literatures has been described.