Comparative Study on the Efficacy of Different Cycloplegic Agents in Myopic Adults

PURPOSE: To evaluate the efficacy of 3 cycloplegic regimens in adults with myopia. METHODS: Refraction, accommodation amplitude, residual accommodation and biometric findings were assessed before and after instillation of regimen I (tropicamide 0.5% and phenylephrine 0.5%), regimen II (cyclopentolate 1.0%), and regimen III (combination of regimen I and II). RESULTS: In myopic adults aged 22 to 26 years, cycloplegic refraction revealed less myopia than manifested refraction. Although there was no difference in residual accommodation among the 3 regimens, regimen II and III were more effective in reducing myopia, accommodation, and axial length. The difference in cycloplegic refraction between regimen I and II was more prominent in patients who had larger amplitude of accommodation and residual accommodation with regimen I. CONCLUSIONS: Cycloplegic refraction should be used even in adult myopes. For patients with stronger accommodation and larger residual accommodation with tropicamide, cycloplegic refraction with cyclopentolate may be used to ensure relaxation.

A Case of Thelazia Callipaeda Recurred At a One-month Interval

PURPOSE: To report a relapsed case of an intra-conjunctival Thelazia callipaeda infestation within one month. CASE SUMMARY: A 59-year-old female patient presented with symptoms of itching and a sense of foreign substance in her left eye, which she had been experiencing for several days. Conjunctival hyperemia and follicle multiplication along with ten actively moving worms were identified and were extracted with forceps. The symptoms disappeared until 25 days later, when they recurred and five additional worms were extracted. All of the extracted worms were confirmed to be Thelazia Callipaeda and the patient's symptoms disappeared after the final extraction. CONCLUSIONS: More than one month of follow-up observation is required for human infection by Thelazia Callipaeda due to the post-extraction growth of the larva.

A Case of Needleless Jet Injector Induced Bilateral Chorioretinal Injury

PURPOSE: To report a case of bilateral chorioretinal injury by needleless jet injector misuse. CASE SUMMARY: In a dermatology department, the patient was diagnosed as having total alopecia and was scheduled to be injected on her eyelash by needleless jet injector for treatment but inexpert doctor injected on the eyelid, not eyelash, by mistake. She then suddenly complained of blurred vision and a floater just after that procedure and was referred to the ophthalmology department. Bilateral vitreous hemorrhage and preretinal hemorrhage were seen during indirect ophthalmoscopic examination and bilateral prophylactic argon laser photocoagulation was done around the suspicious tear site. Then bilateral vitreous hemorrhage and preretinal hemorrhage were absorbed and we found a partial retinal rupture lesion and choroidal rupture lesion in the right eye and a retinal injury lesion in the lefteye. Therefore we observed the lesions of both eyes continuously without further treatment. Her clinical symptoms improved. CONCLUSIONS: Needleless jet injector has many advantages, especially less pain and injury than a normal needle injector and is usually used in clinic as preoperative local anesthesia and steroid injection in many medical fields. In this case, the needleless injector was accidentally misused inducing both direct and indirect choroidal rupture and retinal injury. In general, while a needleless jet injector is used in ophthalmology department, we have to use it with the greatest care.