To Compare Long-Term Follow-Up Adjustable and Non-Adjustable Surgery Success Rates in Horizontal Strabismus Surgery

PURPOSE: To compare the long-term follow-up surgical success rate of adjustable and non-adjustable surgery in horizontal strabismus. METHODS: A retrospective analysis was performed. The patients aged 15 years or older who were diagnosed with horizontal strabismus between September 2004 and August 2007 and who underwent at least 6 months of follow-up after surgery were reviewed. Eleven patients (Group A) underwent adjustable surgery, and 20 patients (Group B) underwent non-adjustable surgery. The surgical success rate of 31 patients with 6 months of follow-up were compared. After 2 years, the long-term follow-up surgical success rates of 10 patients in Group A and 12 patients in Group B were compared. Additionally, the changes between deviation angle on postoperative day 1 and final follow-up were compared. RESULTS: The success rates 6 months after surgery was 81.8% in Group A and 85.0% in Group B, a difference that was not statistically significant (p = 0.82). The success rate over 2 years of follow-up after surgery was 80.0% in Group A and 58.3% in Group B, and the difference was not statistically significant (p = 0.28). However, the change in deviation angle was more stable in Group A than in Group B, and standard deviation, skewness, and kurtosis were lower in Group A. CONCLUSIONS: After 2 years of follow-up, the success rate of adjustable surgery was higher than the non-adjustable surgery (Group A 80%, Group B 58.3%, p = 0.28). Moreover, in adjustable surgery, the changes in deviation angle were smaller and more stable.

Comparison of OVD and BSS for Maintaining the Anterior Chamber during IOL Implantation

PURPOSE: To compare surgical results between conventional intraocular lens (IOL) implantation using an ophthalmic viscosurgical device (OVD) and IOL implantation using a balanced salt solution (BSS) after irrigation/aspiration (I/A) of the lens cortex. METHODS: A randomized prospective study was conducted on 62 patients who underwent cataract surgery. Following completion of conventional I/A of the lens cortex, we divided patients into two groups according to whether or not BSS was used. In group A (n = 31), the anterior chamber and the capsular bag were completely filled with an OVD before IOL implantation. On the other hand, in group B (n = 31), BSS was irrigated into the anterior chamber through a previous side port during IOL implantation. Surgical results were compared between the two groups. RESULTS: In both groups, IOP peaked six hours after surgery. The occurrence of an IOP spike by postoperative day one was observed in six cases (6 / 31) in group A and in no cases (0 / 31) in group B, a difference that was statistically significant (p = 0.024). The values of endothelial cell density, central corneal thickness, anterior chamber inflammation, myopic shift, and posterior capsule opacification were not significantly different between the two groups. CONCLUSIONS: Compared with the use of OVD for IOL implantation, use of BSS during IOL implantation resulted in reductions in postoperative IOP spike and OVD removal time.

Surgical Outcomes of Different Ahmed Glaucoma Valve Implantation Methods between Scleral Graft and Scleral Flap

PURPOSE: To compare the surgical outcomes of the two different methods used for Ahmed Glaucoma Valve (AGV) implantation between the donor scleral graft method and the partial-thickness scleral flap method. METHODS: We retrospectively reviewed medical records of 28 eyes of 26 patients diagnosed as neovascular glaucoma followed by AGV implantation. Based on the surgical method, the included eyes were divided into two groups. In the graft group (n = 18), the drainage tube was inserted into the anterior chamber, and then covered with preserved donor sclera. In the flap group (n = 10), the drainage tube was inserted under the partial-thickness scleral flap, and then covered with the flap. We compared the postoperative intraocular pressure (IOP), surgical success rates, and postoperative complications between the two groups. RESULTS: Postoperative IOP was not significantly different between the two groups (p = 0.967, 0.495 at 12 months, 24 months, respectively, by the Mann-Whitney U-test). The mean success periods were 53.1 +/- 10.1 months in the graft group versus 50.9 +/- 9.4 months in the flap group (p = 0.882 by log rank test), and cumulative success rates were 77.8% and 80.0% at one year, respectively. However, tube migration occurred more frequently in the flap group than in the graft group (p = 0.037 by Fisher's exact test). CONCLUSIONS: In AGV surgery for neovascular glaucoma, the scleral graft method may be associated with relatively less complication about tube migration than the scleral flap method. The surgical results, however, were not statistically different.

Surgical Outcomes of Different Ahmed Glaucoma Valve Implantation Methods between Scleral Graft and Scleral Flap

PURPOSE: To compare the surgical outcomes of the two different methods used for Ahmed Glaucoma Valve (AGV) implantation between the donor scleral graft method and the partial-thickness scleral flap method. METHODS: We retrospectively reviewed medical records of 28 eyes of 26 patients diagnosed as neovascular glaucoma followed by AGV implantation. Based on the surgical method, the included eyes were divided into two groups. In the graft group (n = 18), the drainage tube was inserted into the anterior chamber, and then covered with preserved donor sclera. In the flap group (n = 10), the drainage tube was inserted under the partial-thickness scleral flap, and then covered with the flap. We compared the postoperative intraocular pressure (IOP), surgical success rates, and postoperative complications between the two groups. RESULTS: Postoperative IOP was not significantly different between the two groups (p = 0.967, 0.495 at 12 months, 24 months, respectively, by the Mann-Whitney U-test). The mean success periods were 53.1 +/- 10.1 months in the graft group versus 50.9 +/- 9.4 months in the flap group (p = 0.882 by log rank test), and cumulative success rates were 77.8% and 80.0% at one year, respectively. However, tube migration occurred more frequently in the flap group than in the graft group (p = 0.037 by Fisher's exact test). CONCLUSIONS: In AGV surgery for neovascular glaucoma, the scleral graft method may be associated with relatively less complication about tube migration than the scleral flap method. The surgical results, however, were not statistically different.

A Case of Bilateral Papilledema and Visual Field Defect in Pediatric Idiopathic Intracranial Hypertension

PURPOSE: To report a case of bilateral papilledema and visual field defect in pediatric idiopathic intracranial hypertension. CASE SUMMARY: The 5-year-old female patient was admitted to the hospital, complaining of headache and vomiting of 3 weeks duration. After admission, she complained of diplopia. The uncorrected visual acuity was 0.3 in the right eye and 0.8 in the left. An alternative prism cover test showed approximately 35 PD esotropia, with a -2 abduction limitation of both eyes. Fundus examination showed bilateral papilledema and peripapillary retinal hemorrhages. No abnormality was found in the MRI and CT, symptoms of headache, vomiting, bilateral papilledema, and esotropia with normal neurologic examination. Therefore, she was diagnosed with pediatric idiopathic intracranial hypertension. In Humphrey visual field test, MD was -14.15 dB in right and -16.58 dB in the left eye. Also, the general sensitivity of visual field decreased. Acetazolamide (Diamox(R)) was given orally for 30 days. Forty-four days after the initial visit, peripapillary retinal hemorrhages and vessel tortuosity decreased. Furthermore, visual acuity improved to 1.0 in the right eye and 0.9 in the left. The esotropia reduced to 5 PD, and MD improved to -4.83 dB in the right eye and -5.24 dB in the left.

A Case of Bilateral Retinal Hemorrhages Caused by Plasmodium Vivax Malaria

PURPOSE: To report a case of bilateral retinal hemorrhages caused by Plasmodium vivax malaria. CASE SUMMARY: The 38-year-old male patient with cyclic high fever for 48 hours was admitted to the department of internal medicine in our hospital. He complained of decreased visual acuity of the left eye. The best corrected visual acuity was 1.0 in right eye and 0.3 in left eye. His blood hemoglobin concentration was 7.5 g/dl. Fundus examination revealed retinal hemorrhages in the posterior pole and preretinal hemorrhage in the macular area in his left eye. The peripheral blood smear confirmed Plasmodium vivax malaria. Hydroxychloroquine and Premaquine were given orally. Forty-nine days after the initial visit, retinal hemorrhages in the posterior pole and preretinal hemorrhage in the macula area occurred in his right eye. Although retinal hemorrhages in both eyes were reduced 100 days after the initial visit, the best corrected visual acuity was 0.2 in right eye and 0.4 in left eye and visual acuity did not improve. CONCLUSIONS: Retinal hemorrhages infrequently can occur by Plasmodium viviax malaria and can result in permanent visual loss.

An Immunohistochemical Study of ErbB4 Receptor in Alzheimer's Disease Hippocampus / 대한해부학회지

Neuregulin-1 (NRG1) signaling participates in numerous neurodevelopmental processes. Although ErbB4, a key NRG1 receptor, is expressed in multiple regions in the adult animal brain, little is known about its expression in aged human brain. We show that ErbB4 immunoreactivity was shown regional difference in the hippocampus of age-matched control and that the distribution of these molecules was altered in Alzheimer's disease (AD) brains. Immunohistochemical characterization of the distribution of ErbB4 receptor in the hippocampus relative to pathology staging were performed in age-matched control (Braak stage I/II, n=5), early AD (Braak stage III/IV, n=5) and advanced AD(Braak stage V/VI, n=10). The intensity of ErbB4 immunoreactivity was higher in neurons of the CA2 than that in CA1 or CA3 in the age-matched control. Particularly, in the early AD, ErbB4 immunoreactivity was significantly increased in the apoptotic cells of the CA2 field. In the advanced AD, ErbB4 immunostaining was more intense in the apoptotic cell of the CA2 field. In the dentate gyrus (DG), ErbB4-positive granular cell density was gradually increased in proportion to the progression of pathology of AD brains. We have also found that ErbB4 immunostaining was increased in the nucleus, suggesting that the presenilin-dependent cleavage of ErbB4 generates the soluble ErbB4 ICD (intracellular domain) that translocalized to the nucleus. Together, these results provide the immunohistochemical analysis of ErbB4 receptor in the human hippocampus staged by the progression of pathology of AD.