Comparison of Surgical Outcomes with Unilateral Recession and Resection According to Angle of Deviation in Basic Intermittent Exotropia

PURPOSE: The purpose of this study is to compare the surgical outcomes and near stereoacuities after unilateral medial rectus (MR) muscle resection and lateral rectus (LR) recession according to deviation angle in basic intermittent exotropia, X(T). METHODS: Ninety patients with basic type X(T) were included in this study. They underwent unilateral recession of the LR and resection of the MR and were followed postoperatively for at least 12 months. Patients were divided into three groups according to their preoperative deviation angle: group 1 or =40 PD. Surgical outcomes and near stereoacuities one year after surgery were evaluated. Surgical success was defined as having a deviation angle range within +/-10 PD for both near and distance fixation. RESULTS: Among 90 patients, groups 1, 2, and 3 included 30 patients each. The mean age in groups 1, 2, and 3 was 9.4 years, 9.4 years, and 11.0 years, respectively. The surgical success rates one year after surgery for groups 1, 2, and 3 were 80.0%, 73.3%, and 73.3% (chi-square test, p = 0.769), respectively. The undercorrection rates for groups 1, 2, and 3 were 16.7%, 23.3%, and 26.7%, and the overcorrection rates were 3.3%, 3.3%, and 0%, respectively. The mean preoperative near stereoacuities for groups 1, 2, and 3 were 224.3 arcsec, 302.0 arcsec, and 1,107.3 arcsec, and the mean postoperative near stereoacuities were 218.3 arcsec, 214.7 arcsec, and 743.0 arcsec (paired t-test; p = 0.858, p = 0.379, p = 0.083), respectively. CONCLUSIONS: In basic X(T) patients, the amount of angle deviation has no influence on surgical outcomes in unilateral LR recession and MR resection. The near stereoacuities by one year after LR recession and MR resection for intermittent X(T) were not different among patient groups separated by preoperative deviation angle.

Treatment of Lower Eyelid Swelling after Retrobulbar Hyaluronic Acid Filler Injection in Phthisis Bulbi

PURPOSE: To report treatment with hyaluronidase of lower lid swelling lasting for 1 year after retrobulbar hyaluronic acid filler injection due to phthisis bulbi. CASE SUMMARY: A 54-year-old female presented with right lower eyelid swelling lasting 1 year. There was no tenderness in the right lower eyelid but Tyndall effect was observed. Ultrasonographic findings showed soft tissue swelling in the right lower eyelid. The patient had 3 mm enophthalmos in the right eye on exophthalmometry due to phthisis bulbi resulting from trauma 10 years prior to presentation. Retrobulbar hyaluronic acid filler (Juvederm voluma; Allergan, Irvine, CA, USA) injections were performed to increase orbital volume; 2 mL of filler was injected in the retrobulbar space twice at 1-month interval. After injections, the patient experienced right lower lid swelling lasting 1 year. The patient was diagnosed with lower eyelid swelling due to anterior filler displacement. Hyaluronidase (H-lase inj 1,500 IU/A; Gunil, Seoul, Korea) was reconstituted in 10 mL of normal saline and 0.1 mL (15 IU) of reconstituted hyaluronidase was injected into the right lower eyelid subcutaneously at 5 different areas. At 5 weeks following injections, the lower eyelid swelling was rarely observed and she was satisfied with the result. CONCLUSIONS: Long-lasting lower lid swelling after retrobulbar hyaluronic acid filler injection can be quickly and effectively treated with hyaluronidase injections.

A Case of Acute Bilateral Solar Retinopathy Diagnosed with Spectral Domain Optical Coherence Tomography

PURPOSE: To report a case of acute bilateral solar retinopathy diagnosed using spectral domain optical coherence tomography (SD-OCT). CASE SUMMARY: A 74-year-old female patient consulted for amblyopia and metamorphopsia at a local hospital. On the patient's first visit, there were no abnormal findings based on slit lamp microscope. Additional examinations were conducted since the patient complained of metamorphopsia with visual acuity and corrected vision. Fundus photography and SD-OCT examination showed symmetrical lesions near the bilateral macula. Several evaluations of the patient's medical history confirmed that the patient was exposed directly to the sun for 30 minutes. One month after the first visit, visual acuity improved but metamorphopsia remained unchanged. Lesion status could not be confirmed by fundus photography. There was no abnormal finding on fluorescence angiography. SD-OCT examination still showed bilateral symmetric disruption of the outer retina but with no significant interval change. CONCLUSIONS: In the present case, the patient with bilateral intraocular lenses who complained of acute binocular amblyopia was diagnosed accurately through SD-OCT tests for bilateral symmetric disruption on the outer retina and repetitive evaluations of patient's medical history.

Analysis of Aqueous Humor Cytokines in Diabetic Retinopathy

PURPOSE: To investigate the relationship between the concentration of aqueous humor cytokines and the severity of diabetic retinopathy. METHODS: Thirty-six subjects were included in the control, non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) groups, each group has 12 patients. Aqueous levels of cytokines (interleukin (IL)-1alpha, IL-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), monocyte chemoattractant protein (MCP)-1, interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha) were investigated according to the severity of diabetic retinopathy. RESULTS: When the control group was compared with the PDR and NPDR groups, aqueous levels of IL-6 were significantly higher in PDR patients than in those of both the control and NPDR groups (p = 0.016 and p = 0.003, respectively). The aqueous levels of VEGF were significantly higher in the eyes of PDR patients than in those of the control group (p = 0.003). There were no statistically significant differences between the 3 groups with regard to other cytokines. CONCLUSIONS: Aqueous levels of IL-6 and VEGF were higher in the eyes of PDR patients than in those of healthy controls.

Analysis of Aqueous Humor Cytokines in Diabetic Retinopathy

PURPOSE: To investigate the relationship between the concentration of aqueous humor cytokines and the severity of diabetic retinopathy. METHODS: Thirty-six subjects were included in the control, non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) groups, each group has 12 patients. Aqueous levels of cytokines (interleukin (IL)-1alpha, IL-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), monocyte chemoattractant protein (MCP)-1, interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha) were investigated according to the severity of diabetic retinopathy. RESULTS: When the control group was compared with the PDR and NPDR groups, aqueous levels of IL-6 were significantly higher in PDR patients than in those of both the control and NPDR groups (p = 0.016 and p = 0.003, respectively). The aqueous levels of VEGF were significantly higher in the eyes of PDR patients than in those of the control group (p = 0.003). There were no statistically significant differences between the 3 groups with regard to other cytokines. CONCLUSIONS: Aqueous levels of IL-6 and VEGF were higher in the eyes of PDR patients than in those of healthy controls.

The Ratio of Accommodative-Convergence to Accommodation in Patients with Intermittent Exotropia

PURPOSE: To measure the ratio of accommodative-convergence to accommodation (AC/A ratio) in patients with pseudodivergence excess type and convergence insufficiency type of intermittent exotropia [X(T)], and to compare with a normal group. METHODS: A total of 55 subjects were divided into 3 groups: pseudodivergence excess type, convergence insufficiency type, and normal group. Age, gender, and refractive error of patients were examined. The deviation angle was measured at near and distance by using a prism cover test, followed by an interpupillary distance measurement. The AC/A ratio was calculated using a heterophoria and a gradient method. RESULTS: There was no statistically significant difference in age, gender, and the refractive errors among the 3 groups. The mean value of AC/A ratio using the heterophoria method was 9.50 in pseudodivergence excess type patients, 2.59 in convergence insufficiency type patients, and 5.47 in the normal group. Using the gradient method, the mean value of AC/A ratio was 1.47, 0.03, and 2.08 in each group, respectively. There was no statistically significant difference in mean values between patients with pseudodivergence excess type and the normal group, except when obtained using the gradient method (p = 0.43). CONCLUSIONS: A distinct difference in AC/A ratio existed when computed by the heterophoria method between patients with pseudodivergence excess type or convergence insufficiency type and the normal group. In the gradient method, however, the ratios of convergence insufficiency type patients were lower compared to the normal group, indicating the gradient method is more accurate than the heterophoria method.

The Ratio of Accommodative-Convergence to Accommodation in Patients with Intermittent Exotropia

PURPOSE: To measure the ratio of accommodative-convergence to accommodation (AC/A ratio) in patients with pseudodivergence excess type and convergence insufficiency type of intermittent exotropia [X(T)], and to compare with a normal group. METHODS: A total of 55 subjects were divided into 3 groups: pseudodivergence excess type, convergence insufficiency type, and normal group. Age, gender, and refractive error of patients were examined. The deviation angle was measured at near and distance by using a prism cover test, followed by an interpupillary distance measurement. The AC/A ratio was calculated using a heterophoria and a gradient method. RESULTS: There was no statistically significant difference in age, gender, and the refractive errors among the 3 groups. The mean value of AC/A ratio using the heterophoria method was 9.50 in pseudodivergence excess type patients, 2.59 in convergence insufficiency type patients, and 5.47 in the normal group. Using the gradient method, the mean value of AC/A ratio was 1.47, 0.03, and 2.08 in each group, respectively. There was no statistically significant difference in mean values between patients with pseudodivergence excess type and the normal group, except when obtained using the gradient method (p = 0.43). CONCLUSIONS: A distinct difference in AC/A ratio existed when computed by the heterophoria method between patients with pseudodivergence excess type or convergence insufficiency type and the normal group. In the gradient method, however, the ratios of convergence insufficiency type patients were lower compared to the normal group, indicating the gradient method is more accurate than the heterophoria method.

Intravitreal Bevacizumab Injection for Choroidal Neovascularization Secondary to Laser Photocoagulation for Central Serous Chorioretinopathy

PURPOSE: To report a case of intravitreal bevacizumab injection for choroidal neovascularization following direct laser photocoagulation for central serous chorioretinopathy. CASE SUMMARY: A 44-year-old male patient with an 8-month history of metamorphopsia in his left eye visited our clinic and was diagnosed with central serous chorioretinopathy after performing refraction, fundus examination, fluorescein angiography (FAG) and optical coherence tomography (OCT). After 1 month, laser photocoagulation of the leaking point observed on the FAG was performed. After 8 weeks following laser photocoagulation, visual acuity was reduced to 0.4, subretinal hemorrhage accompanied by choroidal neovascularization was observed on FAG and OCT, and an intravitreal bevacizumab injection was administered. After 4 weeks following the injection, macular edema and subretinal hemorrhage decreased, visual acuity increased to 1.0 and was maintained properly. However, after 2 years, the central serous chorioretinopathy recurred and after 3 months, healed spontaneously. CONCLUSIONS: Intravitreal bevacizumab injection is a safe and effective treatment for secondary choroidal neovascularization occurring after direct laser photocoagulation for central serous chorioretinopathy. In addition, a single treatment can maintain the patient's status with no recurrence of choroidal neovascularization over a long-term period.

Soft tissue change of the midface in skeletal class III orthognathic surgery patients / 대한치과교정학회지

PURPOSE: The first objective of this study was to compare the upper midface morpholgy, focusing on the soft tissues, between skeletal Class III maloccusion patients with midfacial depression and the norm. The second objective was to estimate and analyze the change in the upper midface soft tissues following surgical correction with maxillary advancement by Lefort I osteotomy and mandibular setback by bilateral sagittal split osteotomy (BSSRO). METHODS: The samples consisted of 34 adult patients (15 males and 12 females) with an average age of 21years, who had severe anteroposterior discrepancy with midfacial depression. These patients had received presurgical orthodontic treatment and surgical treatment which consisted of simultaneous Lefort I osteotomy and BSSRO. RESULTS: The correlation coefficient between changes in maxillary advancement and changes in Or' (soft tissue orbitale) was 0.599 (p < 0.05). Change in maxillary plane angle and vertical change of the maxilla were not correlated with the change in Or' (p < 0.05). The ratio of soft tissue change in Or' to maxillary advancement was 43.57 %, and 81.54 % in Sn. Regression equations between maxillary movement and Or' were devised. The r2 value was 0.476. CONCLUSIONS: The majority of measurements in the upper midface in skeletal Class III maloccusions when compared to the norm, showed significant differences. In Class III malocclusion with midfacial depression, maxillary advancement produces soft tissue change in the upper midface.