Surgical Correction of V-pattern Esotropia and Inferior Oblique Overaction in a Patient with Craniosynostosis

Purpose@#We describe the use of bilateral medial rectus recession with inferior transposition and inferior oblique myectomy to treat a patient with craniosynostosis exhibiting V-pattern esotropia and inferior oblique overaction.Case summary: An 8-year-old girl with esotropia and a history of cranioplasty for craniosynostosis visited our clinic. Her best-corrected visual acuity (BCVA) was 0.5 and 0.3 in the right and left eye, respectively. Latent nystagmus was observed in both eyes. She exhibited 40 prism diopters (PD) of esotropia in the primary position, 30 PD during upgaze, and 45 PD during downgaze. Bilateral superior oblique underaction and inferior oblique overaction were observed. Fundus examination revealed excyclotorsion in both eyes. Computed tomography (CT) revealed superior displacement of both medial rectus muscles. She underwent 5.5-mm medial rectus recession with inferior transposition and inferior oblique myectomy in both eyes. After 9 months, she exhibited 5 PD of dissociated vertical deviation at far distance in the right eye, and 10 PD of exotropia with 5 PD of dissociated vertical deviation at near distance. Ductions and versions were within the normal range in both eyes. @*Conclusions@#Bilateral medial rectus recession with inferior transposition and inferior oblique myectomy is useful in patients exhibiting V-pattern esotropia and inferior oblique overaction in association with craniosynostosis.

Surgical Correction of V-pattern Esotropia and Inferior Oblique Overaction in a Patient with Craniosynostosis

Purpose@#We describe the use of bilateral medial rectus recession with inferior transposition and inferior oblique myectomy to treat a patient with craniosynostosis exhibiting V-pattern esotropia and inferior oblique overaction.Case summary: An 8-year-old girl with esotropia and a history of cranioplasty for craniosynostosis visited our clinic. Her best-corrected visual acuity (BCVA) was 0.5 and 0.3 in the right and left eye, respectively. Latent nystagmus was observed in both eyes. She exhibited 40 prism diopters (PD) of esotropia in the primary position, 30 PD during upgaze, and 45 PD during downgaze. Bilateral superior oblique underaction and inferior oblique overaction were observed. Fundus examination revealed excyclotorsion in both eyes. Computed tomography (CT) revealed superior displacement of both medial rectus muscles. She underwent 5.5-mm medial rectus recession with inferior transposition and inferior oblique myectomy in both eyes. After 9 months, she exhibited 5 PD of dissociated vertical deviation at far distance in the right eye, and 10 PD of exotropia with 5 PD of dissociated vertical deviation at near distance. Ductions and versions were within the normal range in both eyes. @*Conclusions@#Bilateral medial rectus recession with inferior transposition and inferior oblique myectomy is useful in patients exhibiting V-pattern esotropia and inferior oblique overaction in association with craniosynostosis.

Relationship between Dominant Eye and Refractive Error in Myopic Anisometropia

PURPOSE: To investigate the relationship between dominant eye and refractive error in patients with myopic anisometropia. METHODS: This study population consisted of myopes less than 15 years old who were followed up for anisometropia defined as interocular difference of spherical equivalent (SE) ≥1.0 diopter (D). All patients underwent the hole-in-the-card test at far and near to determine ocular dominance. The data were analyzed for statistical significance using Fisher's exact test. RESULTS: A total of 102 eyes in 51 patients were analyzed. The mean age of the patients was 10.4 ± 1.4 years and 54.9% were male. The mean SE was −2.97 ± 1.95 D in the right eye and −3.02 ± 1.92 D in the left eye. The right eye was the dominant eye in 43.1% and 37.3% at distance and near, respectively. The agreement of dominancy between distant and near was 82.4%. The near dominant eyes showed statistically significant accordance with more myopic eyes (p = 0.009). On the other hand, there was no statistically significant relationship between more myopic eyes and distant dominant eyes (p = 0.09). CONCLUSIONS: The near dominant eye was more myopic eye in patients with myopic anisometropia. This was considered to be related with the lag of accommodation in dominant eye with near distance.

Williams Syndrome with Ocular Manifestations

PURPOSE: To report two cases of Williams syndrome with ocular manifestations CASE SUMMARY: A 5-year-old boy who was diagnosed with Williams syndrome visited our hospital for ophthalmic examination. Best corrected visual acuity (BCVA) in both eyes was 0.6. He had myopic astigmatism and 8 prism diopters of esotropia. Oval-shaped pupil with a stellate pattern of the iris and increased retinal vascular tortuosity were seen in both eyes. Another case of an 8-year-old boy with Williams syndrome also had myopia in both eyes. BCVA was 0.7 in the right eye and 0.4 in the left eye. A stellate pattern of the iris and increased retinal vascular tortuosity were also seen in both eyes. CONCLUSIONS: Williams syndrome, deletion of 7q11.23, has ocular anomalies including a stellate pattern of the iris, refractive errors, amblyopia, and strabismus. Therefore, careful ophthalmic examination should be considered when children are diagnosed with Williams syndrome.

A Case of Toxic Keratitis due to Chronic Use of Sodium Hyaluronate Eyedrops

PURPOSE: To report a case of toxic keratitis due to chronic use of sodium hyaluronate eyedrops. CASE SUMMARY: A 74-year-old female visited our clinic with severe ocular pain and decreased vision in both eyes. She had received refractive surgeries in both eyes 10 years prior. She had been using sodium hyaluronate eyedrops for the treatment of dry eye symptoms for 10 years. Slit-lamp examination revealed inferior punctate erosions in the inferior part of the cornea in both eyes. With her history of chronic use of sodium hyaluronate and after ophthalmologic examination, we suspected keratitis medicamentosa due to sodium hyaluronate eyedrops. We discontinued the eyedrops she was using and prescribed autologous serum. One month later, ocular discomfort and decreased vision were improved and corneal erosions were decreased. CONCLUSIONS: In the present case, toxic keratitis was assumed to be associated with the use of sodium hyaluronate eyedrops and corneal erosions improved after the eyedrops were discontinued. We suggest sodium hyaluronate eyedrops are potentially hazardous and recommend a regular follow-up should be performed by a qualified ophthalmologist.

Primary Orbital MALT Lymphoma Associated with Localized Amyloidosis

PURPOSE: To report a case of primary orbital MALT lymphoma with localized amyloidosis. CASE SUMMARY: A 61-year-old male visited our clinic with diplopia, which had developed approximately 5 months earlier. Magnetic resonance imaging of the orbit showed an ill-defined well-enhanced mass in the left inferior orbit. Incisional biopsy of the orbital mass was performed. Histopathological examination revealed diffuse deposits of an amorphous, eosinophilic substance in the extracellular matrix and vessels with lymphocytes infiltration. Lymphocytes were positive for the immunohistochemical stain against the CD20 and kappa-light chain antigens. The amorphous material stained positive for kappa-light chain antigen, and Congo red staining showed birefringence. CONCLUSIONS: We report a rare case of primary orbital MALT lymphoma associated with localized amyloidosis.

Conjunctival Hypertrophic Scar Following Cryotherapy for Retinopathy of Prematurity

A 6-year-old boy was referred to our hospital with symblepharon and lateral canthal deformity in both eyes, which developed 6 years ago. The patient was born at 27 weeks gestation. He had received cryotherapy for retinopathy of prematurity. One month after cryotherapy, he developed a conjunctival scar with symblepharon in both eyes and underwent symblepharon lysis at another hospital 5 years prior. Ocular examination revealed an extensive conjunctival hypertrophic scar with symblepharon and limitation of extraocular movements. An excisional biopsy, lateral canthoplasty, and symblepharon lysis with conjunctival autograft from the contralateral eye were performed in the left eye. Histopathologic examination revealed diffuse proliferation and infiltration of collagenous tissue.

Risk Factors for Rapid Visual Field Progression in Normal-Tension Glaucoma

PURPOSE: To evaluate risk factors of rapid visual field progression in normal-tension glaucoma. METHODS: The authors of the present study reviewed the medical records of patients with normal-tension glaucoma who were treated between 2001 and 2011. The rapid progression group was composed of patients who showed a visual field index progression rate of -1.0%/yr using a Humphrey visual field analyzer (HFA). Age, sex, diabetes, hypertension, migraine history, family history of glaucoma, refractive error, central corneal thickness, disc hemorrhage, beta-zone parapapillary atrophy, baseline mean deviation, pattern standard deviation, initial IOP, mean follow-up IOP, peak IOP, IOP fluctuation, and number of eye drops between the 2 groups were compared. RESULTS: Among the 52 patients with normal-tension glaucoma, 26 were classified into the rapid progression group and 26 were classified into the slow progression group. The mean visual field index progression rate was -3.92%/yr and -0.42%/yr, respectively. In the univariable model, migraine history, disc hemorrhage, beta-zone parapapillary atrophy, and number of eye drops were associated with rapid visual field progression. According to multivariate analysis, disc hemorrhage and number of eye drops were statistically significant risk factors. CONCLUSIONS: Disc hemorrhage and number of eye drops were associated with rapid visual field progression in normal tension glaucoma patients.