A Case of Amantadine-Induced Corneal Edema

PURPOSE: To report a rare case of corneal edema caused by amantadine. CASE SUMMARY: A 35-year-old man was diagnosed with hypoxic brain damage caused by ventricular fibrillation. The patient showed Parkinsonism and was started on treatment with amantadine. Thirty-seven months after the commencement of amantadine treatment, the patient suffered a corneal ulcer in his right eye, which healed with opacity and thinning after medical treatment. After healing, slit-lamp examination revealed a bilateral, epithelial and stromal edema without obvious guttae and keratic precipitates. The corneal edema did not improve with topical treatment of 5% NaCl and 0.02% fluorometholone in both eyes. Three months after leaving the hospital, the patient's corrected visual acuity decreased to 0.2 (-2.0 Dsph -0.5 Dcyl Ax 90) in the right eye and 0.4 (-0.75 Dsph -2.0 Dcyl Ax 90) in the left eye. Amantadine medication was discontinued after discussion with the patient's neurologist. At the 1-month follow-up, corneal examination revealed resolution of the epithelial and stromal edema in both eyes. Corrected visual acuity was improved to 0.5 (-1.5 Dsph) in the right eye and 0.7 (-1.0 Dsph -1.0 Dcyl Ax 90) in the left eye. CONCLUSIONS: In cases of corneal edema without an obvious causative disease, the patient's systemic medication list must be reviewed and amantadine should be considered as a possible cause.

PAX6 Mutations and Clinical Features of Congenital Aniridia

PURPOSE: To report the PAX6 mutations and clinical features in Korean aniridia patients. METHODS: Genomic DNA was isolated from 12 aniridia patients and 5 normal controls. The coding regions of the PAX6 gene were analyzed by direct sequencing of polymerase chain reaction products. The relationship between the mutational types and the ophthalmic findings from medical records was determined. RESULTS: Mutation analysis demonstrated seven different types of mutations, five of which have not previously been reported. Notably, these mutations were confined to PD and LNK in the PAX6 gene. Although R44X and W156X were recurrent mutations, novel mutations included G18R, IVS6+1insG, A139P, A139A, and G141G. Glaucoma was found in five (42%, adult patients 30 years or older) of twelve patients, of whom four were male. CONCLUSIONS: This is the first report to identify the PAX6 gene mutations in Korean aniridia patients. Our limited data show that glaucoma was more prevalent in male and adult patients. Moreover, a patient's age along with the PAX6 genotype might be a factor related to glaucoma in aniridia patients.

Clinical Course of Young Adults With Central Retinal Vein Occlusion

PURPOSE: To describe the clinical course of young patients with central retinal vein occlusion (CRVO). METHODS: We reviewed the records of patients 50 years or younger who presented with CRVO and who were followed up for at least 6 months. RESULTS: The average age of the patients was 37.7 years, and the mean follow-up time was 26.3 months. Participants included 27 patients with CRVO younger than 50 years among the total 393 patients with CRVO, and the sex distribution was nearly equal; 13 patients were male and 14 patients were female. Associated systemic diseases were hypertension (8 patients), diabetes (3 patients), stroke (3 patients), and myocardial infarction (1 patient). Of the 17 patients who had no systemic disease, 8 patients had hypercholesterolemia or another hematologic abnormalities. Of the 18 eyes with non-ischemic CRVO, 10 eyes (55.6%) showed improved final visual acuities (2 or more lines). Of the 9 eyes with ischemic CRVO, only 1 eye (11.1%) showed improved visual acuity. CONCLUSIONS: Hematological examination and treatment with systemic evaluation were recommended to younger patients with CRVO. The classification of retinal ischemia of young patients as well as that of older patients could be useful for the follow-up of patients and the assessment of its progression in the future.

A Survey on the Perceptions of Guardians of Pediatric Oculoplastic Patients

PURPOSE: This survey was performed to gather information about the guardians of pediatric oculoplastic patients undergoing certain medical care services in order to recommend improvements in these services. METHODS: Questionnaires were distributed to guardians of pediatric oculoplastic patients who were admitted for operations to correct epiblepharon and ptosis. Completed questionnaires, which numberd 100, were then analyzed. RESULTS: The results of this survey show that most guardians were the parents of the patient; most had a level of education higher than or equal to junior college graduation; and most were middle-class. The parents themselves had discovered their children's disease and had a great influence on the decision to operate. Most parents took an optimistic view of the results of the operation. The higher the guardians' economic status, the more likely he or she believed that both an ophthalmic and a plastic surgeon could perform oculoplastic operations. Many guardians chose an ophthalmic clinic over a plastic surgery clinic because the likelihood of a satisfactory result is higher and because these diseases are related to visual acuity. Half of the guardians knew that there is an oculoplastic clinic at the department of ophthalmology, and many of them gathered information about oculoplastic surgery from the internet. CONCLUSIONS: Better explanations about oculoplastic diseases and more education about these diseases should be available to the guardians of patients with these diseases. Systematic publicity for the field of oculoplastic surgery is needed urgently, and the availability of accurate information and specialized medical counseling about these diseases on the internet should be increased.