A Case of Granular Cell Tumor of the Orbit

PURPOSE: To report a case of granular cell tumor of the orbit in a patient, complaining of foreign body sensation due to entropion. CASE SUMMARY: A 59-year-old man visited our clinic because of foreign body sensation in the right eye due to entropion. A white mass was noted at the right palpebral conjunctiva, and bulbar conjunctiva chemosis was seen. We performed excisional biopsy and capsulopalpebral fascia repair for lower lid entropion. Histopathological examination revealed a granular cell tumor. There were no complications after surgery. CONCLUSIONS: Granular cell tumor of the orbit is rare, but it should be considered in the differential diagnosis of a mass lesion causing entropion or diplopia.

Occlusive Retinal Vasculitis Associated with Intravenous Ceftriaxone Injection

PURPOSE: To report a case of bilateral occlusive retinal vasculitis presumed to be associated with intravenous ceftriaxone injection. CASE SUMMARY: A 26-year-old woman presented with a sudden visual impairment which developed 2 days earlier in her left eye combined with an anaphylactoid reaction. The patient was administered intravenous ceftriaxone (2 g / day) 9 times for 14 days due to aggravation of chronic osteomyelitis on her left ankle. There were no adverse events until the 7th intravenous ceftriaxone administration. However, anaphylactoid reactions occurred shortly after the 8th and 9th administration. On the 1st visit, her best corrected visual acuity in the right eye was 1.0, and in the left eye 0.1. On fundus examination, retinal hemorrhages and perivascular sheathing were observed in the superonasal area in the right eye and in the entire retina in the left eye. Anterior chamber cell reactions were not noted on slit lamp examination, and vitritis was absent in both eyes. Laboratory data showed no conclusive evidence of autoimmune or origin of infection. On the last visit, 25 months after the initial visit, the patient's best corrected visual acuity was 0.02 in the left eye and visual acuity and fundus appearance were normal in the right eye. CONCLUSIONS: Bilateral occlusive retinal vasculitis may be associated with intravenous ceftriaxone injection, and immunological and serological tests should be performed thoroughly along with history taking to clarify the cause of retinal vasculitis.

Ocular Diseases and Hypertension / 대한내과학회지

No abstract available.

Predictive Factors of Successful Weaning From Glasses in Accommodative Esotropia Patients

PURPOSE: To investigate the predictive factors of successfully weaning children from glasses with accommodative esotropia who were monitored with manifest refraction on follow-up visits. METHODS: A retrospective review of 48 patients with accommodative esotropia was performed. Weaning was accomplished by monitoring patients with manifest refraction on follow-up visits. The patients were divided into 2 groups: patients who were weaned successfully from glasses and patients who still needed glasses at their final visit. A comparative analysis of the multiple clinical features between the 2 groups was performed. RESULTS: Among the 48 patients, 15 patients were weaned successfully from glasses. The age of onset was significantly different between the 2 groups, 39.6 +/- 14.9 months in patients who were weaned successfully from glasses and 30.7 +/- 16.9 months in patients who still needed glasses. In particular, the patients with onset of accommodative esotropia after 3 years of age were more likely to be weaned from glasses at their final visit. CONCLUSIONS: Monitoring with manifest refraction could be another method of weaning children from glasses with accommodative esotropia and the age of onset appears to be the useful predictor of successful weaning in children who can finally be weaned from glasses.

Association of Visceral Fat and Risk Factors for Metabolic Syndrome in Children and Adolescents

PURPOSE: Visceral fat (VF) is closely associated with many metabolic risk factors and is also known to be a strong predictive factor for severe metabolic complications in adults. But there are only a few studies concerning the association of VF and risk factors for metabolic syndrome (MS) in children and adolescents. In our study, we emphasized the association of VF [measured by VF computed tomography (VFCT)] and risk factors for metabolic syndrome in children and adolescents. MATERIALS AND METHODS: The subjects were outpatients aged 6 to 18 years who underwent VFCT in the family medicine of The Catholic University of Korea from January 2005 to August 2009. There were 82 patients in total (42 children, 40 adolescents). Height, weight, blood pressure (BP), blood tests, body composition analysis and VF were measured. The three groups were also classified by metabolic score. RESULTS: In children, only high density lipoprotein cholesterol (HDL-C) showed a statistically significant difference, while in adolescents, triglyceride, HDL-C, BP, body mass index (BMI), waist circumference (WC) and VFA showed statistically significant differences. In terms of VFA, fasting glucose, BP, BMI, basal metabolic rate (BMR) and WC showed statistically significant differences. BMI showed a statistically significant difference in terms of BP, BMR, WC, VFA and HDL-C. CONCLUSION: There is a need to acknowledge the statistically significant associations of VF and risk factors for MS in children and adolescents. Screening tests for BP, cholesterol, fasting glucose and WC should be given in clinics for children and adolescents so that MS can be detected and its risk factors treated early.

Therapeutic Effects of Anti-Tumor Necrosis Factor Monoclonal Antibody on Experimental Uveitis

PURPOSE: We investigated the therapeutic effects of monoclonal anti-TNF antibody (infliximab) on experimental uveitis. METHODS: Twenty New Zealand White rabbits were immunized with Mycobacterium tuberculosis H37Ra antigen and then challenged with intravitreal injection of tuberculin antigen to introduce a uveitis. Then infliximab was injected into rabbit eyes at an intravenous concentration of 5 mg/kg and intravitreal concentrations of 1 mg/0.1mL and 100 microg/0.1mL. As a control, the vehicle was injected intravenously or intravitreally. To evaluate the therapeutic effects, inflammation was assessed by slit lamp biomicroscopy and scored according to the severity of inflammation. The animals were also evaluated by electroretinography and histopathology. RESULTS: Regardless of the administration route, inflammatory activities of anterior chamber and engorgement of vascular structures were reduced in the infliximab treated group compared to control. Different administration routes and different concentrations of infliximab did not affect the therapeutic outcome of the clinical scoring. Intravenous (5 mg/kg) and intravitreal diluted (100 microg/0.1mL) infliximab injection groups showed significant improvement in electroretinographic findings and significant reduction of inflammatory cells with preservation of retinal tissue architecture on histopathologic examination. However, focal loss of the photoreceptor outer segment is observed in intravitreal undiluted (1 mg/0.1 mL) infliximab injected eyes. CONCLUSIONS: Infliximab may be a useful treatment modality to suppress ocular inflammation in experimental uveitis models in rabbits.

The Retinal Nerve Fiber Layer Analysis in Eyes with Small Optic Disc

PURPOSE: Eyes with small optic disc may be infirm to glaucomatous damage but suitable and objective methods for monitoring glaucomatous optic nerve damage in small optic disc are limited. The purpose of this study was to evaluate the usefulness of the retinal nerve fiber layer (RNFL) analysis using scanning laser polarimetry in patients with small optic disc. METHODS: 63 patients with small optic disc were recruited in this study. Eyes with average disc diameter 1.617 mm or less which was 33 percentile by topographic scanning system in our normal population study were enrolled. There were 26 patients with normal tension glaucoma and 37 patients with normal visual fields. Each patient underwent RNFL analysis using GDx VCC. Measurements of axial length, intraocular pressure, refractive error, disc diameter and cup/disc ratio were fulfilled. Findings were compared with independent t-test between 2 groups. GDx VCC parameters were analyzed with multiple logistic regression analysis. RESULTS: No differences in age, axial length, intraocular pressure, refractive error and disc diameter were apparent between the two groups. However, significant differences were detected in GDx VCC parameters including TSNIT average, Superior average, TSNIT standard deviation, NFI, Superior ratio, Inferior ratio, Sup/nasal, Maximum modualation, Superior maximum and Normalized superior area (p<0.001). The RNFL damage of superior area was prominent. CONCLUSIONS: In the patients with small optic disc, it is hard to detect the pathologic glaucomatous change by their disc morphologies. Therefore, RNFL analysis could be useful for a glaucoma screening of the patients with small optic disc.

Clinical Manifestations of Intraocular Pressure Elevation after Intravitreal Injection of Triamcinolone Acetonide

PURPOSE: To evaluate the incidence of intraocular pressure (IOP) elevation and the associated factors following intravitreal triamcinolone acetonide injection. METHODS: A retrospective observational case study was performed in 143 eyes of 143 patients who received intravitreal injection of 4 mg triamcinlone acetonide and who had a minimum follow-up of 6 months. The eyes were examined before and periodically after the intravitreal injection of triamcinolone acetonide. A significant IOP elevation was defined as IOP>21 mmHg or a rise of more than 5 mmHg in patient with IOP over 21 mmHg at their first examination. RESULTS: Mean IOP increased from 16.1+/-3.2 mmHg preoperatively to 23.3+/-7.7 mmHg postoperatively. A significant IOP elevation was observed in 68 eyes (47.6%). IOP elevation was observed the day after injection and decreased to the baseline value after 6 months following injection. The time to reach maximum IOP was 3 months in 24.5%, 2 months in 20.3% and 1 week in 12.6%. Factors associated with IOP elevation were younger age, high IOP before injection, myopia, and unaccompanying anterior chamber paracentesis. Most cases of IOP elevation following intravitreal triamcinolone acetonide injection were controlled by antiglaucoma medication. However, in 4 eyes, filtering surgery or valve implantation was required. CONCLUSIONS: IOP elevation after intravitreal triamcinolone injection is common and may take an extended period of time to manifest. Cautious monitoring of IOP is recommended after intravitreal triamcinolone injection especially in younger patients and those with high IOP before injection, myopia, and unaccompanying anterior chamber paracentesis.