Brain Abscess Formation Accompanied by Improvement of Orbital Cellulitis

PURPOSE: To present a case of brain abscess formation accompanied by improvement of orbital cellulitis. CASE SUMMARY: A 54-year-old male came to our clinic complaining of swelling and pain of the left periorbital area and decreased visual acuity (VA) of the left eye. Initial best-corrected visual acuity (BCVA) was 0.3 and intraocular pressure was 27 mmHg in the left eye. Eye movement in all directions was restricted and 4 mm of proptosis was observed in the left eye. An orbital CT scan demonstrated pansinusitis and orbital cellulitis of the left eye. The patient underwent endoscopic sinus surgery and was treated with systemic antibiotics. However, periorbital swelling was aggravated and another orbital CT scan was performed and analyzed. The CT scan showed localized periorbital abscess of the left eye, and the authors performed an incision and drainage (I&D) of abscess procedure. After the operation, BCVA of the left eye was recovered to 0.8 and eye movement improved and periorbital swelling decreased. However, 15 days after the I&D, the patient complained of a severe headache. Brain magnetic resonance imaging (MRI) was performed and showed an abscess of the left frontal lobe of the brain. The authors consulted with a neurosurgeon, and the patient received intravenous antibiotics and mannitol. The headache steadily decreased, and three months after the first visit, a follow-up brain MRI was performed. The MRI showed almost complete disappearance of the abscess and six months after the first visit, BCVA was recovered to 1.0 and eye movement was full in all directions. CONCLUSIONS: Although orbital cellulitis is improved by treatment of antibiotics and surgery, if the patient complains of neurologic symptoms such as headache, other complications such as brain abscess formation should be considered.

Augmented Asymmetric Lateral Rectus Recession in Intermittent Exotropia With Fixing Eye

PURPOSE: To document and compare the clinical results of symmetrical rectus muscle recession and asymmetrical rectus muscle recession in intermittent exotropia. METHODS: The medical records of 27 patients who had symmetric bilateral rectus recession and 24 patients who had asymmetric bilateral rectus recession for intermittent exotropia with at least six months of postoperative follow-up from March 2004 to March 2007 were reviewed retrospectively. The authors performed a recession of 2 mm or greater in the deviating eye than in the fixing eye. RESULTS: The mean age was 7.14+/-4.23 (range 3 to 15) years for symmetric bilateral rectus recession and 7.33+/-4.01 (range 3 to 14) years for asymmetric bilateral rectus recession. The mean follow-up was 11.83+/-5.74 (range 6 to 26) months in the symmetric bilateral rectus recession group and 11.14+/-5.05 (range 6 to 30) months in the asymmetric bilateral rectus recession group. The mean preoperative angle deviations were 27.5+/-4.8 prism diopter (PD) (range 30 to 40PD) and 27.3+/-4.6PD (range 20 to 40PD) in each group. The outcome of final follow-up (postoperative 24 months) was favorable in both groups, and slightly more successful in the asymmetric bilateral recession group but not a statistically significant amount (75.5% in the symmetric bilateral recession group and 81.2% in the asymmetric bilateral recession group). CONCLUSIONS: The present study suggests that there are no significant differences at postoperative 24 months between symmetric bilateral recession and asymmetric bilateral recession in intermittent exotropia having a fixing and a deviating eye.

2007 Survey for KSCRS Members: Current Trends in Cataract Surgery in Korea

PURPOSE: This study investigated the current situation and future trends in the field of cataract surgery in Korea. METHODS: Since 1995, the members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have conducted annual surveys regarding cataract and refractive surgery. The 2007 annual survey, consisting of 85 multiple-choice questions, was mailed in February 2008 to 301 KSCRS members. Sixty-two (20.6%) members answered the questions. Current data were compared with data from previous annual surveys and with surveys in the United States and Europe. RESULTS: Fifty-four percent of the respondents were over 50 years of age. The duration of hospital stay has decreased annually and the use of topical anesthesia (57%) has slightly increased. Self-sealing wound construction was the main wound closure technique in phacoemulsification (60%). The implantation of phakic intraocular lenses (IOL) was performed in 56% of the respondents and the most preferred IOL for small incision cataract surgery were acrylic (88%). Interest in the additional value of IOL has increased annually. CONCLUSIONS: This survey summarized current trends and changes in cataract surgery in Korea.

Tractional Retinal Detachment After Intravitreal Bevacizumab (Avastin(R)) Injection in Proliferative Diabetic Retinopathy

PURPOSE: To report two cases of tractional retinal detachment after intravitreal bevacizumab injection. CASE SUMMARY: (Case 1) A 48-year-old female with insulin-dependent diabetes mellitus and a high HbA1c level came to our clinic for fundus evaluation. The best corrected visual acuity (BCVA) was 1.0 in the right eye and funduscopic examination of the right eye revealed proliferative diabetic retinopathy with preretinal hemorrhage and a mild fibrovascular proliferative membrane around the optic disc. Intravitreal bevacizumab injection (1.25 mg) was performed before starting panretinal photocoagulation (PRP) to prevent macular edema after PRP. Three days after the injection, visual acuity decreased to 0.3 and funduscopic findings showed tractional retinal detachment. Vitrectomy was performed and visual acuity recovered to 1.0 four months after operation. CONCLUSIONS: Intravitreal bevacizumab injection may cause tractional retinal detachment in poorly controlled insulin-dependent diabetes mellitus patients with fibrovascular proliferative membranes.