In-Depth Interview of Parents Experienced First Infant Oral Examination / 치위생과학회지

The purpose of this study is to analyze the experience of the parents who examined the first infant oral examination and to understand how to improve the practical oral examination business. In-depth interviews were held with 10 parents who did the first infant oral examination, and their children's age was less than 18 to 29 months. The following conclusions were obtained by deriving the concepts and categories of the recorded contents. First, the main reason for the unsatisfactory examination of this study was that it was formal. Parents were disappointed in the fact that they did not look at the mouth of the child at the same time as it was fast and they said because it is carried out free of charge, it is more formal than the examination for general dental treatment. Second, most of the participants questioned whether they should resume infant oral examination. Third, it appears that the tooth number or dental terminology in the result notice is difficult to understand. Fourth, the opinion on the improvement of the infant oral examinations was should provided that the oral health management information after examination and the direct oral health management method education at the examination. In addition, we identified the need for parents' oral health care education for infants. Therefore, it has been confirmed that in order for the infant oral examination and young children to be practically carried out, the problems should be improved by collecting opinions of the parents. Also it is necessary to search for efficient business management method through repeated research related to infant oral examination.

Atypical Ocular and Optical Coherence Tomographic Findings With Presumed Miliary Tuberculosis

PURPOSE: To report clinical features and optical coherence tomographic findings of presumed atypical ocular tuberculosis associated with tuberculosis lymphadenitis and encephalomeningitis. CASE SUMMARY: A 28-year-old female with lymphadenitis in the axillary area presented with a fever and headache of a one week duration. CSF study and MRI findings implied tuberculosis encephalomeningitis, and presumed tuberculosis uveitis manifested with visual disturbance after five days. Ocular symptoms were aggravated and showed anterior iridocyclitis, vitritis, macular edema, and multifocal retinitis with miliary granuloma that was distinct from choroiditis or typical tuberculosis granuloma. After the patient received anti-tuberculosis medication and systemic corticosteroids, significant improvements in visual acuity, ocular findings and OCT results were observed. CONCLUSIONS: Ocular tuberculosis can present with various clinical findings, and caution should be taken so as not to misdiagnose based on these characteristics. In the present case, anti-tuberculosis medication and systemic steroids resulted in the resolution of inflammation. In such cases, monitoring the posterior pole lesion via OCT may be helpful in determining improvement.

Wyburn-Mason Syndrome: A Case Report

PURPOSE: To describe a case of Wyburn-Mason Syndrome, which is characterized by arteriovenous malformations in the central nervous system and the retina. CASE SUMMARY: A 13-year-old girl who underwent neurosurgical intervention for intraventricular hemorrhage was referred to our ophthalmic clinic because brain angiogram and MRI finding revealed arteriovenous malformations (AVMs) that extended from the orbit and optic chiasm along the optic pathway. Fundus and fluorescein angiography of the left eye showed marked dilation and tortuosity of the retinal vessels. Fluorescein angiographic findings showed rapid filling of all vessels and no dye leakage. CONCLUSIONS: Retinal racemose hemangioma should be considered for Wyburn-Mason syndrome, and the finding of retinal AVMs should warrant cerebral imaging studies including MRI and angiography.

A Case Refort of Sandhoff Disease

Sandhoff disease is a rare autosomal recessive metabolic disease presenting bilateral optic atrophy and a cherry red spot in the macula. This case report presents the characteristics of a patient with Sandhoff disease as assessed by ophthalmic, neuroimaging, and laboratory procedures. Ophthalmologic examination revealed that the patient could not fixate her eyes on objects nor follow moving targets. A pale optic disc and a cherry red spot in the macula were seen in both eyes. Low signal intensity at the thalamus and high signal intensity at the cerebral white matter were noted in a T2-weighted brain MR image. A lysosomal enzyme assay using fibroblasts showed the marked reduction of both total beta-hexosaminidases, A and B. Based on the above clinical manifestations and laboratory findings, we diagnosed the patient as having Sandhoff disease.

Investigation of Hemodynamic Changes in the Ophthalmic Artery using Color Doppler Imaging after Strabismus Surgery

PURPOSE: We investigated hemodynamic changes in the ophthalmic artery (OA) using color Doppler imaging (CDI) after two horizontal rectus muscles surgery. METHODS: Eyes of the surgical group (n=18) underwent surgery on two horizontal rectus muscles, and the control group was the contralateral eyes. CDI of the OA was performed before operation and on postoperative days (POD) 1, 7 and 30. Peak systolic (Vmax), end diastolic (Vmin), and mean (Vmean) blood flow velocities were measured, and resistivity index (RI) and pulsatility index (PI) were calculated. RESULTS: Vmax, Vmin and Vmean were significantly higher, and RI and PI were significantly lower in the surgical group than in the control group on POD 1 (p< 0.05). In the surgical group, Vmax, Vmin and Vmean were significantly higher, and RI and PI were significantly lower, on POD 1 than those mesured on other days (p< 0.05). CONCLUSIONS: We showed that surgery on the two horizontal rectus muscles increased OA blood flow during the early postoperative period.

A Case of Bilateral Upgaze Palsy associated with Unilateral Midbrain Hemorrhage in Moyamoya Disease

PURPOSE: To report a case of bilateral upgaze palsy associated with unilateral midbrain hemorrhage in moyamoya disease. METHODS: A 29-year-old woman presented with a sudden decrease of consciousness and was diagnosed with a spontaneous brain hemorrhage in the right side of the midbrain, right basal ganglion, and third ventricle. The mentality was improved after external ventricular drainage of hemorrhage, but bilateral upgaze difficulty remained. We performed neuro-ophthalmic and radiologic evaluation of the cause of bilateral upgaze difficulty. RESULTS: She showed a upgaze limitation of -2 grade in the right eye and -3 grade in the left eye, but normal movements in other versions and ductions. There were normal responses in pupillary light reflex, forced duction and convergence tests, but no ocular elevation in the vertical vestibulo-ocular reflex. The Bell's phenomenon was absent. She was diagnosed with moyamoya disease through brain MRI and cerebral angiography, and we found a hemorrhage in the right area of the midbrain. This hemorrhagic area was consistent with the right rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF). We think that the bilateral upgaze palsy was caused by damage to the riMLF in the affected side and to projections through the posterior commissure.

Five-year Follow-up of Refractive Error and Visual Acuity in Preschool Children

PURPOSE: The purpose of this study is to evaluate visual acuity and refractive state in preschool children and to find the environmental factors that cause visual acuity and refractive change. METHODS: The initial subjects were 3, 225 preschool children, aged 4 to 6 years old, selected randomly from 15 preschools in Daejeon from August to November, 1997. Among them, 759 (23.5%) children showed 0.6 or less visual acuity or had different visual acuity of more than 2 lines between two eyes. In addition, 537 (70.8%) children who did not showed organic ocular abnormality during the first examination received refraction. Five years later, 120 (22.3%) children were reexamined and enrolled in this study. RESULTS: Uncorrected visual acuity was 0.44 (log MAR -0.36 +/- 0.27) and corrected visual acuity was 0.85 (logMAR -0.07 +/- 0.09) on average in 1997. Generally there was a myopic shift by -1.30 +/- 1.16 diopter (D) for 5 years (p<0.001) and astigmatism was significantly decreased by 0.32 +/- 0.48 D in the hyperopic group (p<0.001). The amount of myopic shift was lower in the children who were wearing eyeglasses than in those who were not in the hyperopic group (p<0.05). Corrected visual acuity was significantly increased by 0.13 (logMAR 0.06 +/- 0.08, p<0.001). The degree of myopic shift was larger in the children whose parents were wearing eyeglasses than in those whose parents were not wearing eyeglasses (p<0.05) but other environmental factors did not influence on visual acuity or refractive change. CONCLUSIONS: Early examination of visual acuity and refractive state, and adequate treatment are important to increase visual function in preschool children.

Effect of Both Medial Rectus Recession in Large Angle Infantile Esotropia

PURPOSE: To evaluate of the effect of bilateral medial rectus recession in the patients who showed large angle (>50 prism diopters, PD) infantile esotropia as comparing small angle (50 PD, 14 patients) and small angle group (

Comparison of Corneal Power Measured by Different Methods after Refractive Surgery

PURPOSE: To compare the corneal power (K) measured by different methods in the patients who underwent photorefractive keratectomy (PRK) or laser in situ keratomilieusis (LASIK) METHODS: Fifty-four patients who had undergone PRK or LASIK from December 1999 to December 2000 and followed for 3 months or longer were selected for this study. The corneal power was measured by five different methods in 35 eyes(18 patients) of PRK group and in 70 eyes (36 patients) of LASIK group: calculation method (C-K), hard contact lens method (H-K), autorefractokeratometer (A-K), manual keratometer (M-K) and topography (T-K). RESULTS: Preoperative mean corneal power was 43.41+/-1.06 D in PRK group and 43.75+/-1.03 D in LASIK group. Postoperative corneal power in PRK group showed following Results: C-K, 40.94+/-1.51 D; H-K, 41.04+/-1.23 D; A-K, 41.18+/-1.29 D; M-K, 41.38+/-1.33 D; T-K, 41.67+/-1.26 D. In LASIK group, the results were: C-K, 38.64+/-2.25 D; H-K, 39.29+/-1.66 D; A-K, 39.53+/-1.61 D; M-K, 39.85+/-1.54 D; T-K, 40.36+/-1.26 D. The corneal power of calculation method was lowest in both groups. Each corneal power was not different statistically from the others in PRK group(p=0.16). However, C-K was significantly lower than A-K (p=0.02), M-K (p=0.00) or T-K (p=0.00) in LASIK group. Also, H-K or AK was lower than T-K statistically in LASIK group (p=0.00, p=0.02). CONCLUSIONS: The corneal power was lowest when measured by calculation method after refractive surgery. In LASIK group, there were statistical differences among the corneal powers by each method.

Effect of Unilateral Lateral Rectus Recession for Intermittent Exotropia under 25 PD

PURPOSE: To investigate the surgical outcome of unilateral lateral rectus recesssion in the treatment of intermittent exotropia under 25 prism diopter (PD). METHODS: The 62 patients who had underwent unilateral lateral rectus recession and followed up for 6 months or larger, were reviewed. Following inferotemporal fornix incision, 8.5 mm or 9.5 mm recession from the insertion of lateral rectus was performed in 20 PD or in 25 PD intermittent exotropia respectively. RESULTS: Mean age of patients was 8.8 years (5-14 years) and follow up time was 11.5 months (6-34 months) on average. Postoperative deviation and success rate were as followings: -0.2+/-2.1 PD, 91.9% at postoperative 1 day, 0.5+/-2.3 PD, 95.2% at postoperative 1 week, 2.5+/-3.9 PD, 96.8% at postoperative 1 month, 3.7+/-5.0 PD, 91.9% at postoperative 6 month and 4.3+/-5.5 PD, 85.7% at postoperative 1 year. The average divergent shift was 4.5 PD during whole examination period and this shift showed significant change during same period (Repeated measures, p=0.000). The occurrence rate of undercorrection was 1.6% at postoperative 1 week, 3.2% at postoperative 1 month, 8.1% at postoperative 6 month and 14.3% at postoperative 1 year. The occurrence rate of overcorrection was 8.1% at postoperative 1 day and 3.2% at postoperative 1 week. All cases of overcorrection were orthophoric after postoperative 1 month. The limitation of abduction was not discovered in all cases at postoperative 1 year. CONCLUSIONS: Unilateral recession of lateral rectus is an effective method in the treatment of intermittent exotropia under 25 PD. However long term follow up should be considered since undercorrection seems to be increasing.

Effect of High dose Corticosteroid and Optic Canal Decompression on Traumatic Optic Nerve Injury

PURPOSE: To evaluate the effect of high dose corticosteroid and optic canal decompression on the traumatic optic nerve injury. METHODS: Twenty six patients who were diagnosed to have traumatic optic nerve injury, were divided into two groups in which one group received corticosteroid therapy while the other group underwent optic canal decompression combined with corticosteroid therapy. RESULTS: Visual acuity increased by > OR =3 lines of LogMAR scale in 47% of the corticosteroid group, in 28% of operation and steroid group, and in 42% of overall cases. But the degree of visual acuity improvement had no difference between two groups(p=0.72). As the patients were divided into two groups based on initial visual acuity such as no light perception and light perception or better, the initial visual acuity did not have influence on the final visual outcome in both corticosteroid group and operation and steroid group(p=0.78, p=0.33). CONCLUSIONS: This result suggest that effect of high dose corticosteroid and optic canal decompression on traumatic optic nerve injury is not different.