Survey of Surgical Management in Intermittent Exotropia

Purpose@#To obtain an overview of the surgical practices for the management of intermittent exotropia among experienced surgeons. @*Methods@#We conducted a survey of members of the Korean Association for Pediatric Ophthalmology and Strabismus, who had experience of > 15 years in strabismus surgery, via e-mail. Surgical methods for basic-type intermittent exotropia, angle of deviation for determining the surgical dose, reasons for surgical dose adjustment, and the postoperative target angle of deviation were analyzed. @*Results@#Bilateral lateral rectus recession was preferred over unilateral recession and resection for basic-type intermittent exotropia with or without a dominant eye. The preoperative maximum angle of deviation was preferred for determining the surgical dose by 56% of the participants. Two-thirds of the participants preferred to reduce the surgical dose in specific circumstances, lateral incomitancy being the most common reason. In case of true divergence excess-type intermittent exotropia, 47.7% of the participants reduced the surgical dose. The most preferred target angle of deviation at 1 day postoperatively was 11-15 prism diopter esodeviation, as reported by 40% of the participants. @*Conclusions@#Although experienced surgeons had different surgical preferences for intermittent exotropia, a general trend was found. This survey may be a useful reference for beginners in strabismus surgery.

Posterior Ischemic Optic Neuropathy after Cervical Spine Surgery

Purpose@#To describe a patient with posterior ischemic optic neuropathy (PION) after cervical spine surgery who recovered after treatment.Case summary: A 51-year-old woman presented with eye pain and decreased visual acuity in the left eye, which had begun 8 hours after cervical spine surgery in the prone position. Her best-corrected visual acuity (BCVA) was 20/20 in the right eye and hand motion in the left eye; a relative afferent pupillary defect was present in the left eye. Ductions and versions were normal with pain in the left eye. The results of slit lamp examination, fundoscopic examination, fluorescein angiography, and optical coherence tomography were unremarkable in both eyes. Brain and orbital magnetic resonance imaging showed no abnormal findings in the visual pathway, such as brain infarction or intracranial artery stenosis. The patient was diagnosed with PION in the left eye. Because postoperative anemia had developed with a rapid decrease in hemoglobin from 14.7 g/dL to 9.9 g/dL, red blood cell (RBC) transfusion was performed together with intravenous high-dose steroid therapy and subcutaneous epoetin alfa injection. After 3 weeks, the patient’s BCVA improved to 20/22 in the left eye. @*Conclusions@#Unilateral PION developed after cervical spine surgery in the prone position. Visual improvement was observed after RBC transfusion, intravenous high-steroid therapy, and subcutaneous epoetin alfa injection.

Optic Perineuritis as a Presenting Sign of Sarcoidosis

Purpose@#To report a rare case of optic perineuritis as the presenting sign of sarcoidosis. Case summary: A 57-year-old man presented with decreased visual acuity and pain with extraocular movement in his left eye starting 2 weeks earlier. He had a history of asymptomatic optic perineuritis in that eye 18 months previously, which had improved after 1 month on oral prednisolone. His best corrected visual acuity had decreased to 20/50 and he also had relative afferent pupillary defect and color vision defects in the left eye. Slit lamp examination results were normal. There were no inflammatory reactions in the anterior chamber or vitreous. Fundoscopy showed optic disc edema. Orbital magnetic resonance imaging showed diffuse enhancement surrounding the left optic nerve. The serum levels of eosinophil cationic protein and angiotensin- converting enzyme were markedly increased. A chest radiograph showed bilateral hilar lymph node enlargement. A biopsy via endobronchial ultrasound-guided transbronchial needle aspiration revealed multifocal non-caseating granulomas. Acid fast bacilli stain showed no evidence of tuberculosis. Based on these findings, he was diagnosed with sarcoidosis. After treatment with high-dose intravenous methylprednisolone and subsequent tapering with oral prednisolone for 6 months, the visual acuity improved. @*Conclusions@#Optic perineuritis can be the initial sign of sarcoidosis. Therefore, sarcoidosis should be considered in the differential diagnosis of optic perineuritis.

Optic Perineuritis as a Presenting Sign of Sarcoidosis

Purpose@#To report a rare case of optic perineuritis as the presenting sign of sarcoidosis. Case summary: A 57-year-old man presented with decreased visual acuity and pain with extraocular movement in his left eye starting 2 weeks earlier. He had a history of asymptomatic optic perineuritis in that eye 18 months previously, which had improved after 1 month on oral prednisolone. His best corrected visual acuity had decreased to 20/50 and he also had relative afferent pupillary defect and color vision defects in the left eye. Slit lamp examination results were normal. There were no inflammatory reactions in the anterior chamber or vitreous. Fundoscopy showed optic disc edema. Orbital magnetic resonance imaging showed diffuse enhancement surrounding the left optic nerve. The serum levels of eosinophil cationic protein and angiotensin- converting enzyme were markedly increased. A chest radiograph showed bilateral hilar lymph node enlargement. A biopsy via endobronchial ultrasound-guided transbronchial needle aspiration revealed multifocal non-caseating granulomas. Acid fast bacilli stain showed no evidence of tuberculosis. Based on these findings, he was diagnosed with sarcoidosis. After treatment with high-dose intravenous methylprednisolone and subsequent tapering with oral prednisolone for 6 months, the visual acuity improved. @*Conclusions@#Optic perineuritis can be the initial sign of sarcoidosis. Therefore, sarcoidosis should be considered in the differential diagnosis of optic perineuritis.

Visual Field Ratio According to Distance in the Near Tangent Screen Test

Purpose@#We evaluated the normative range of visual field ratio according to distance in the near tangent screen test performed in adults. @*Methods@#Adults above 18 years of age were prospectively recruited and underwent the near tangent screen test between February and August 2020. We developed a near tangent screen testing device, which was used at 10 and 20 cm distances from the screen. The tangent ratios (TRs), defined as the ratio of the visual field at the further distance to that at the closer distance, were analyzed according to the eight meridians, and the normative value of the TR in adults was deduced. @*Results@#The experiment was performed for 80 eyes of 40 adults. Their average age was 30.9 ± 7.0 years (range, 21-48). The mean TRs were 0.95 ± 0.10 and 0.97 ± 0.10 for the right and left eyes, respectively, so the visual field in either eye did not differ significantly according to distance. The average TR value for the eight meridians was 0.96 ± 0.10 (range, 0.73-1.23), and the TR did not show any significant difference among the eight meridians. The far and near visual fields did not intersect or overlap in any meridian, showing a TR value larger than 0.5. @*Conclusions@#Under the near tangent screen test, the visual fields in normal adults did not differ according to the test distance.

Effect of Ultra-high-definition Television on Ocular Surface and Fatigue

Purpose@#To investigate the effects of watching ultra-high-definition television (UHD TV) on subjective ocular fatigue and objective ocular surface indices. @*Methods@#A total of 76 volunteers were recruited for this study. Subjects watched UHD TV for 10 minutes at a viewing distance of 110 cm. Best-corrected visual acuity, refractive errors, tear break-up time, corneal staining grading, conjunctival redness grading by slit-lamp examination, tear meniscus measurement by anterior segment optical coherence tomography, and ocular symptom scores were obtained before and immediately after watching UHD TV. Subgroup analyses were conducted according to participant age (old age group >50 years vs. young age group ≤50 years) and dry-eye syndrome (presence vs.absence). The relationship between subjective and objective indices was evaluated. @*Results@#The mean age of subjects was 39.6 ± 12.4 years. Watching UHD TV induced a decrease in tear break-up time in the non-dry-eye group (p < 0.001) but not in the dry-eye group (p= 0.726). Corneal staining grades increased in all subgroups, and the changes were particularly larger in the older group (p = 0.038). The increase in ocular symptom scores was larger in the dry-eye group (p = 0.08) and in the older group (p = 0.016). The decrease in tear break-up time and ocular symptom scores after watching UHD TV was significantly correlated with tear break-up time. @*Conclusions@#Tear break-up time significantly decreased in non-dry-eye subjects after watching UHD TV. Subjective ocular discomfort increased significantly in subjects over the age of 50 and in participants with dry-eye syndrome.

Neuro-ophthalmologic Findings in Visual Snow Syndrome

Background@#and Purpose: The findings of ophthalmic examinations have not been systematically investigated in visual snow syndrome. This study reviewed the abnormal neuroophthalmologic findings in a patient cohort with symptoms of visual snow syndrome. @*Methods@#We retrospectively reviewed 28 patients who were referred for symptoms of visual snow to a tertiary referral hospital from November 2016 to October 2019. We defined the findings of best corrected visual acuity (BCVA), visual field testing, pupillary light reflex, contrast sensitivity, full-field and multifocal electroretinography, and optical coherence tomography. @*Results@#Twenty patients (71%) were finally diagnosed as visual snow syndrome. Their additional visual symptoms included illusionary palinopsia (61%), enhanced entoptic phenomenon (65%), disturbance of night vision (44%), and photophobia (65%). A history of migraine was identified in ten patients (50%). The mean BCVA was less than 0.1 logarithm of the minimum angle of resolution, and electrophysiology showed normal retinal function in all patients. Contrast sensitivity was decreased in two of the seven patients tested. Medical treatment was applied to five patients which all turned out to be ineffective. Among the eight patients who were excluded, one was diagnosed with rod-cone dystrophy and another with idiopathic intracranial hypertension. @*Conclusions@#Neuro-ophthalmologic findings are mostly normal in patients with visual snow syndrome. Retinal or neurological diseases must be excluded as possible causes of visual snow.

Development of Optic Disc Torsion in Children

PURPOSE: To document the development of disc torsion. METHODS: Consecutive disc photographs obtained at an interval of at least 1 year were reviewed retrospectively in 173 eyes of 173 Korean children. The angle of the vertical disc axis (AVDA) was measured in each fundus photograph with the fovea-disc center axis set at 0°. The associated change in the morphology of the optic disc was assessed by measuring the ratio of the horizontal to vertical disc diameters and the ratio of the maximum parapapillary atrophy width to vertical disc diameter. Eyes were divided into two groups with respect to the development of disc torsion: torsion and non-torsion group. Progressive torsion was defined as a change in AVDA between baseline and follow-up photographs beyond the coefficient of intraobserver repeatab ility. Factors associated with optic disc torsion were evaluated using logistic regression analysis. RESULTS: Mean subject age and refractive error at the time of baseline fundus examination were 6.8 ± 1.7 (range, 2 to 11) years and 0.2 ± 2.6 (range, −6.0 to +5.5) diopters, respectively. Mean follow-up period was 44.8 ± 21.1 (range, 12 to 103) months. Forty-two eyes (24%) were classified as torsion group who showed changes in AVDA that were greater than the intraobserver measurement variability (4.5°) during the follow-up period. The development of optic disc torsion was associated with greater myopic shift, a decrease in horizontal to vertical disc diameters, and an increase in parapapillary atrophy width to vertical disc diameter. CONCLUSIONS: Progressive optic disc torsion was a common phenomenon in the children included in this study. Torsion occurred as the result of optic disc tilt in an oblique axis in most cases. The findings provide a framework for understanding torsion-related glaucomatous optic nerve damage.

Efficacy of Gaze Photographs in Diagnosing Ocular Myasthenia Gravis

BACKGROUND AND PURPOSE: The various tests that are routinely used to diagnose generalized myasthenia gravis, such as the edrophonium test, serum anti-acetylcholine-receptor antibodies (AChR-Ab), and repetitive nerve stimulation (RNS) tests, have lower diagnostic sensitivity in ocular myasthenia gravis (OMG). Diagnosing OMG becomes even more difficult when the clinical symptoms are subtle. There is no gold-standard diagnostic test available for OMG patients, and so this study compared the diagnostic sensitivity of gaze photographs with conventional tests in OMG. METHODS: Records of gaze photographs were available for 25 of 31 consecutive patients diagnosed with OMG. Each patient underwent a neuro-ophthalmologic examination, serum AChR-Ab, RNS, edrophonium test, ice tests, and the acquisition of gaze photographs. The margin reflex distance 1 (MRD1) was measured on each of the gaze photographs, with MRD1 < 2 mm or an interlid MRD1 difference of ≥2 mm on any of the gaze photographs defined as a positive sign of OMG. The diagnostic sensitivities of the tests were assessed. RESULTS: The mean age at onset was 38.5 years (range, 2–76 years), and 13 patients (52%) were men. The diagnostic sensitivities of the RNS test, AChR-Ab test, gaze photographs, and ice test were 56%, 64%, 80%, and 73%, respectively. CONCLUSIONS: The diagnostic sensitivity was higher for gaze photographs than for the other tests applied to OMG patients.

Treatment of Bilateral Tonic Pupil Associated with Syphilis

PURPOSE: We report a case of a male with bilateral tonic pupils associated with syphilis, that partially improved after syphilis treatment. CASE SUMMARY: A 27-year-old male presented with a 2-month history of near vision impairment. The right and left pupils were 5.5 mm and 6.5 mm in diameter, respectively, in the dark and 5.3 mm and 6.1 mm, respectively, in the light. Both pupils demonstrated light-near dissociation, slow constriction and redilation when looking at near, and constriction after instillation of 0.0625% pilocarpine. Serological tests were positive for syphilis, while cerebrospinal fluid testing was negative. Two months after treatment with intramuscular injection of benzathine penicillin G, his near vision subjectively improved and the right and left pupils were 5.9 mm and 6.4 mm, respectively, in the dark and 4.8 mm and 5.3 mm, respectively, in the light. The size of both pupils decreased and the pupillary light responses partially improved in both eyes. CONCLUSIONS: Patients with bilateral tonic pupils should have serological tests for syphilis. Recovery of tonic pupils can be expected after early treatment with effective antibiotics.

Optic Nerve Sheath Meningioma: Preliminary Analysis of the Role of Radiation Therapy

BACKGROUND: The purpose of this study was to evaluate the treatment outcome of our optic nerve sheath meningioma (ONSM) case series in terms of preventing tumor growth and preserving vision in ONSM patients. METHODS: Between July 2003 and March 2015, 1,398 patients with intracranial meningioma were diagnosed at Seoul National University Bundang Hospital. Among them, only 13 patients (0.93%) were diagnosed with ONSM and enrolled in the present study. Tumor volume changes of ONSM patients and their visual acuity were evaluated before and after treatments. RESULTS: The median follow-up time was 50 months (range, 12–133 months). Visual acuity was evaluated in 12 of 13 patients, and visual acuity was found to be preserved in 9 of 12 patients (75%). Tumor volume was reduced in all patients. The tumor control rate was 100% in the present study. The difference in tumor volume between pretreatment and last follow-up was statistically significant (p=0.015). CONCLUSION: Intensity-modulated radiotherapy (IMRT) and gamma knife radiosurgery (GKS) could maintain visual acuity and stabilize tumor volume in ONSM patients, suggesting that IMRT and GKS may be effective therapies for ONSM. However, which treatment is the more effective modality must be confirmed by prospective studies and longer-term follow-up.

Improvement of divergence insufficiency with treatment of thyroid disease: A case report

@#This is a case that showed improvement of divergence insufficiency after treatment of thyroid disease. A 50-year-old man developed horizontal diplopia a few days prior to presentation while driving a car. On ophthalmologic examination, prism and alternate cover test revealed an esotropia of 8 prism diopters (PD) at distance and exophoria of 2 PD at near in the primary position. He did not show limitation on ductions, or any signs of conjunctival injection, ptosis, eyelid edema, lid lag and proptosis. Orbit and brain magnetic resonance (MR) imaging and MR angiography revealed no abnormal findings in the extraocular muscles and brain. Serum free T4 level was normal and thyroid stimulating hormone (TSH) level was slightly low, while increased levels of thyrotropin-binding inhibitory immunoglobulin (TBII) and antithyroid microsomal antibody were detected. He was managed with glasses of 4 PD base-out prisms in both eyes. Two months later, serum free T4 was elevated and TSH was markedly reduced. TBII was highly elevated and thyroid stimulating immunoglobulin was positive. After 3 weeks of antithyroid treatment with methimazole, his diplopia improved, and prism and alternate cover test showing orthotropia at distance and exophoria of 10 PD at near in the primary position. This case highlights the importance of thyroid function tests and TSH receptor antibodies in patients with acute onset of divergence insufficiency. Divergence insufficiency could be improved with antithyroid treatment.

Imaging of Cranial Nerves III, IV, VI in Congenital Cranial Dysinnervation Disorders

Congenital cranial dysinnervation disorders are a group of diseases caused by abnormal development of cranial nerve nuclei or their axonal connections, resulting in aberrant innervation of the ocular and facial musculature. Its diagnosis could be facilitated by the development of high resolution thin-section magnetic resonance imaging. The purpose of this review is to describe the method to visualize cranial nerves III, IV, and VI and to present the imaging findings of congenital cranial dysinnervation disorders including congenital oculomotor nerve palsy, congenital trochlear nerve palsy, Duane retraction syndrome, Möbius syndrome, congenital fibrosis of the extraocular muscles, synergistic divergence, and synergistic convergence.

Comparison of Blinking Patterns When Watching Ultra-high Definition Television: Normal versus Dry Eyes

PURPOSE: To analyze blinking patterns when watching an ultra-high definition (UHD) television and to compare the results between normal eyes and dry eyes. METHODS: A total of 59 participants aged from 13 to 69 years were instructed to watch a colorful and dynamic video on a UHD television for 10 minutes. Before and after watching the UHD television, we measured the best corrected visual acuities, autorefraction, tear-break-up-time, degree of corneal erosion and conjunctival hyperemia via slit lamp biomicroscopy. In addition, questionnaires for the evaluation of eye fatigue and symptoms of a dry eye were completed. The definition of dry eye syndrome was that the tear-break-up-time of one of the eyes was less than 5 seconds, conjunctival injection, or marked corneal erosion. The number of blinks and the duration of blinking were both measured and analyzed at the early and late phases of video-watching. RESULTS: After watching the UHD television in the normal eye group, the tear-break-up-time was significantly decreased (p < 0.001) and the degree of corneal erosion was significantly increased (p = 0.023). However, the subjective symptoms of participants were not aggravated (p = 0.080). There were no significant differences in blinking patterns in the dry eye group. On the other hand, in the normal eye group, the mean blinking time was significantly increased (p = 0.030). CONCLUSIONS: Watching an UHD television changes the tear-break-up-time, degree of corneal erosion, and blinking pattern in normal eyes, which may increase the risk of dry eye syndrome.

Quantitative Pupillometry of the Pupillary Light Reflex in Koreans

PURPOSE: To determine the normal ranges of various indexes of the pupillary light reflex measured by automated pupillometry in Koreans. METHODS: We retrospectively analyzed 90 healthy adults who did not have any ocular diseases other than refractive errors. The direct pupillary light reflex was measured with an automated dynamic pupillometer (PLR-200, NeurOptics Inc., Irvine, CA, USA). A total of 7 indices were measured as follows; the maximum and minimum pupil diameters, constriction latency, constriction ratio, maximum constriction velocity, average constriction velocity and average dilation velocity. RESULTS: There were no significant differences in quantitative indexes of the pupillary light reflex between fellow eyes. A significant decrease in maximum pupil diameter, minimum pupil diameter, maximum constriction velocity, average constriction velocity and average dilation velocity were observed with aging. In contrast, a significant increase in constriction latency was observed with aging. There were no differences in quantitative pupil measurements according to gender (p<0.001). CONCLUSIONS: Quantitative measurements of the pupillary light reflex by dynamic pupillometry showed no significant differences between fellow eyes. A significant decrease in pupil size, constriction velocity and dilation velocity, and an increase in pupil constriction latency were observed with aging.

Comparison of the antigenic relationship between Japanese encephalitis virus genotypes 1 and 3

PURPOSE: The Japanese encephalitis virus (JEV) genotype circulating in Korea has changed from G3 to G1. Therefore, the purpose of this study was to compare the antigenic relationship between the two genotypes by using antibody tests. MATERIALS AND METHODS: Blood samples from 42 sows and 216 horses were collected, and their seroprevalence was monitored using the hemagglutination inhibition and virus neutralization tests. Antisera against JEV G1 and G3 were isolated and prepared from guinea pigs. The cross-reactivity of these two viruses was then compared using the neutralizing antibody test. RESULTS: We found that there was a difference in the seropositive ratios of JEV G1 and G3. However, the difference was dependent on the antibody test used. There was also an observed difference in the antigenicity between the two genotypes, as ascertained using the neutralizing antibody test. CONCLUSION: There is an evident difference in JEV antigenicity between the genotypes G1 and G3. Therefore, we propose monitoring of the seroprevalence of JEV, and reevaluating the antigenicity of the current vaccine by using the relevant tests.

Clinical Characteristics of Acute Zonal Occult Outer Retinopathy

PURPOSE: To investigate the clinical characteristics of patients with acute zonal occult outer retinopathy (AZOOR). METHODS: Medical records of 13 patients who visited Seoul National University Bundang Hospital from May, 2003 to May, 2015 and diagnosed with AZOOR were retrospectively reviewed. RESULTS: Thirteen patients (11 women and 2 men), with a mean age of 28.5 ± 11.4 years were followed for 42.8 ± 30.3 months. Visual field loss, photopsia, and blurred vision were common complaints. Initially, four patients had bilateral disease and seven patients showed bilateral involvement at the last visit. Mean best corrected visual acuity of involved eyes (BCVA) was 0.75 ± 0.32 (log MAR). Among 20 eyes with AZOOR, BCVA was 20/40 or better in 17 eyes (85.0%). The mean spherical equivalent was -4.59 ± 3.23 diopters (D), and 15 eyes (75.0%) had myopia less than -2.00 D. Nine eyes of seven patients (34.6%) had abnormal fundus findings. All patients underwent full field electroretinogram (ERG) or multifocal ERG and a visual field test. Thirteen patients (100.0%) showed a decreased response in ERG and visual field defects presented in every patient. With respect to the visual field test, 10 eyes (50.0%) showed improvement, 6 eyes (30.0%) had stationary status, and the progression of the visual field defect was observed in 4 eyes (20.0%). Among 13 patients, 4 (30.8%) patients showed flu-like symptom, 4 (30.8%) patients had fatigue, 2 (15.4%) patients had nausea, and 2 (15.4%) patients showed headache. CONCLUSIONS: AZOOR should be considered as one of the differential diagnoses, especially in female patients with myopia who show photopsia or visual field defects. ERG and visual field tests are necessary to confirm a decrease in retinal function and visual field loss. Central vision is preserved in most cases and recovery of visual field defect occurs often.

Reliability and validity of Korean version of modified: Yale preoperative anxiety scale

PURPOSE: The modified Yale Preoperative Anxiety Scale (mYPAS) was developed for evaluating the level of preoperative anxiety in children. The purpose of this study was to develop a Korean version of the mYPAS (K-mYPAS) and to establish its validity and reliability based on the Korean preoperative pediatric patients. METHODS: K-mYPAS was made through stringent back-translation procedure. Total enrolled 102 patients answered questionnaires of Korean version of State-Trait Anxiety Inventory for Children (K-STAIC), and were videotaped for 2 to 5 minutes before induction of anesthesia. Three observers of experienced psychiatrist, surgeon, and nurse analyzed videotape with K-mYPAS comparing to K-STAIC. The inter- and intraobservers reliability, concurrent and construct validity, sensitivity, specificity, and predictive value were analyzed. RESULTS: The value of Cronbach alpha for interobservers reliability was 0.939 and intraobserver reliability was statistically significant (P < 0.001). Concurrent and construct validity were also statistically significant (P < 0.001 and P < 0.001, respectively). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 81.3%, 91.4%, 81.3%, 91.4%, and 88.2%, respectively. CONCLUSION: The K-mYPAS had good psychometric properties and can be used as a reliable and valid instrument for the assessment of preoperative anxiety in children.

Litigations in Ophthalmology for 25 Years in Korea

PURPOSE: To analyze the characteristics of defendants, court rulings and the compensation received in medical disputes relating to ophthalmology. METHODS: Retrospective analyses of ophthalmic claims obtained from websites between 1989 and 2014 were performed. RESULTS: Among 42 cases, 26 cases were ruled partially in favor of plaintiffs and 16 cases, ruled in favor of the defendant. Regarding the type of hospital, private clinics accounted for 22 claims, tertiary referral hospitals took 16 claims, and the secondary hospitals took 6 claims. The judgment amount of all of the lawsuits was Won1,770,466,250 and average amount was Won66,743,168 (Won5,000,000-Won455,869,936). The condition with the highest mean payment per claim was glaucoma (Won223,788,608). The consolation money for emotional distress due to violation of liability for explanation comprised a large proportion of the compensation, accounting for 62% of total payment. The conditions most likely to result in payment were those related to the retina, which occurred in 7 cases (70%). The conditions most likely to be appealed to a higher court were those involving oculoplasty (100%). Mismanagement of tests and misdiagnosis occurred in 8 cases (62%), mismanagement of treatment occurred in 3 cases (23%), and mismanagement of anesthesia and recovery occurred in 1 case (9%). CONCLUSIONS: Among all claims, those involving private clinics were most commonly involved (52%) and 62% of all claims were decided partially in favor of plaintiffs. Violation of liability during the explanation of the condition and negligence during the act of diagnosis and treatment were significant reasons for payment. Examination of these cases will help to promote patient safety and reduce repeated medical disputes.

Litigations in Ophthalmology for 25 Years in Korea

PURPOSE: To analyze the characteristics of defendants, court rulings and the compensation received in medical disputes relating to ophthalmology. METHODS: Retrospective analyses of ophthalmic claims obtained from websites between 1989 and 2014 were performed. RESULTS: Among 42 cases, 26 cases were ruled partially in favor of plaintiffs and 16 cases, ruled in favor of the defendant. Regarding the type of hospital, private clinics accounted for 22 claims, tertiary referral hospitals took 16 claims, and the secondary hospitals took 6 claims. The judgment amount of all of the lawsuits was Won1,770,466,250 and average amount was Won66,743,168 (Won5,000,000-Won455,869,936). The condition with the highest mean payment per claim was glaucoma (Won223,788,608). The consolation money for emotional distress due to violation of liability for explanation comprised a large proportion of the compensation, accounting for 62% of total payment. The conditions most likely to result in payment were those related to the retina, which occurred in 7 cases (70%). The conditions most likely to be appealed to a higher court were those involving oculoplasty (100%). Mismanagement of tests and misdiagnosis occurred in 8 cases (62%), mismanagement of treatment occurred in 3 cases (23%), and mismanagement of anesthesia and recovery occurred in 1 case (9%). CONCLUSIONS: Among all claims, those involving private clinics were most commonly involved (52%) and 62% of all claims were decided partially in favor of plaintiffs. Violation of liability during the explanation of the condition and negligence during the act of diagnosis and treatment were significant reasons for payment. Examination of these cases will help to promote patient safety and reduce repeated medical disputes.