A Case of Recurrent Posterior Scleritis With Hyperthyroidism in Both Eyes

PURPOSE: Posterior scleritis is known to be a rare disease. The authors of the present study herein report a case of posterior scleritis, which occurred in a patient's eye, accompanied by hyperthyroidism and recurring in the other eye one year later. CASE SUMMARY: A 39-year-old female patient visited the hospital for ocular pain in the left eye and a headache. The patient was diagnosed with posterior scleritis through fundus examination, ultrasonography, CT and MRI, and an effective outcome of treatment was obtained by oral administration of methylprednisolone. Four months after discharge, the patient received left subtotal thyroidectomy for thyroid papillary cancer. Seven months after surgery she visited again, due to ocular pain that started 1 week earlier in the left eye, as well as a headache, and was diagnosed with posterior scleritis upon fundus examination, ultrasonography and MRI. Methylprednisolone was administered orally and an effective treatment result was obtained. After discharge, the patient was followed up for 5 months and did not show any signs of recurrence. CONCLUSIONS: When a hyperthyroidism patient has ocular pain or a headache, the possibility of posterior scleritis accompaniment should be considered, as well as the possibility that posterior scleritis, which already occurred in one eye, may recur in the other eye.

The Changes of Intraocular Pressure, Optic Nerve and Visual Field in SCUBA Diving

PURPOSE: To examine how SCUBA diving activities in high-pressure underwater environment affect their intraocular pressure (IOP), visual field (VF), retinal nerve fiber layer (RNFL), and the shape of optic disc. METHODS: We performed visual acuity and refractory test, IOP test, VF test, RNFL photography, optical coherent tomography, and 3D optic disc photography for a group of 32 people and a control group of 32 non-divers, and analyzed the differences between the two groups. For the diver group, we conducted a questionnaire survey on the patterns of diving and diving experience, and analyzed their correlation with results of test. RESULTS: Compared to the Control, the diver group showed significant difference in the mean IOP (diver group: 15.71 +/- 2.54 mmHg, control group: 14.23 +/-2.15 mmHg, p = 0.019), and abnormal visual field (diver group: 7 eyes (11.3%), control group: 0 eye (0%), p = 0.006). 85.7% of abnormal visual field belonged to early defect. The diver group did not showed significant difference in the shape of optic disc (p = 0.546), but the optic nerve atrophy in shape of optic disc test field (diver group: 8 eyes (12.9%), control group: 2 eyes (3.1%), p = 0.042) was significantly different. CONCLUSIONS: Divers who did SCUBA diving activities need to have a glaucoma test regularly. Additional research and large cross or longitudinal study are needed to evaluate causes that scuba diving activities affect.

The Effect of Positional Changes during Heavy Weight Lifting on Intraocular Pressure

PURPOSE: To measure intraocular pressure (IOP) as a function of positional changes of the head during heavy weight lifting. METHODS: The subjects of this study were 30 healthy adult males in their twenties to forties. This study investigated their ophthalmic examinations, BMI (body mass index), and 1RM (one repetition maximum) according to the three bench press positions. RESULTS: Before exercising, the IOP was higher in the lowered head position in the decline bench press (18.20+/-2.89 mmHg) than in the incline bench press (14.38+/-2.32 mmHg) (p<0.001). The IOP increased significantly during the bench press exercise, relative to during the pre-exercise (p<0.001). Upon lift down, IOP increased by 3.72+/-1.85 mmHg greater than upon lift up, and mean IOP increased by 2.61+/-1.63 mmHg (p<0.001). In our experiments, IOP increased to a maximum of 22.10+/-2.79 mmHg, measured during lift down in the decline bench press configuration. The BMI and the IOP before exercise showed significant correlation (p<0.05). CONCLUSIONS: IOP increased more during exercise involving a lower head position. Further study is needed to know the extent to which this result is relevant for glaucoma patients and which activities and head positions during exercise may worsen glaucoma. In the meantime, patients with severe glaucoma may need to avoid lifting heavy objects with a lowered head position.

Isolated Posterior Pole-Penetrating Ocular Injury Treated by Nonsurgical METHODS: A Case Report

PURPOSE: To report a case of isolated posterior pole-penetrating ocular injury treated by nonsurgical methods such as argon laser photocoagulation and administration of antibiotics. CASE SUMMARY: A 46-year-old male visited the hospital complaining of floaters in his left eye which had occurred when his cheek was penetrated by scissors from the inferior posterior part to the superior anterior part while working earlier that day. Upon initial examination, his best corrected visual acuity (BCVA) in the left eye was 0.8, and his intraocular pressure (IOP) was 10 mmHg. No cells or aqueous flares were observed in the anterior chamber. Fundus examination was performed, and three disc diameter-large breaks of the retina and choroid, scleral rupture and vitreous hemorrhage were observed at the posterior pole three disc diameters away from the fovea. It was difficult to make a surgical approach as the lesion was situated on the posterior pole, and there was the risk of prolapse of the eye contents. Therefore, we first performed argon laser photocoagulation around the lesion and administered topical as well as and systemic antibiotics. After admission the patient was observed carefully as the tractional retinal fold was located at the posterior pole. Additional argon laser photocoagulation was performed. After six months of treatment, BCVA in the left eye was 1.0, IOP was 16 mmHg, and no pathologic change was observed on fundus examination.

A Case of Conjunctival Autotransplantation Using Conjunctival Flap of Pterygium in Treating Corneal Ulcer Perforation

PURPOSE: To report a case of conjunctival autotransplantation using the conjunctival flap of the pterygium for thetreatment corneal ulcer perforation. CASE SUMMARY: A 72-year-old woman was referred to our hospital because her left eye had a corneal ulcer due topine needle trauma, and she did not respond to the initial therapy in a private clinic for 1 week. We first applied topical and systemic antibiotics. However, the lesion did not subside, and necrosis progressed in the stroma at the center of the cornea. On day 6 of admission, perforation was found at the center of the cornea, and we excised the necrotic tissue and performed bilateral pedicle conjunctival flap transposition. After the operation, an ischemic change was observed, and in the fourth week perforation occured at the center of the transplanted conjunctival flap. Because we considered it difficult to perform the transplantation of a conjunctival flap in the left eye, we performed autotransplantation on the corneal perforation in the left eye using conjunctival flap obtained through a pterygium excision in the right eye. After the operation, vascular ingrowth started from the edge of the flap, and there were no symptoms of inflammation, shrinkage, or necrosis of the flap. During the follow-up observation, the flap survived well without necrosis.

A Case of Conjunctival Autotransplantation Using Conjunctival Flap of Pterygium in Treating Corneal Ulcer Perforation

PURPOSE: To report a case of conjunctival autotransplantation using the conjunctival flap of the pterygium for thetreatment corneal ulcer perforation. CASE SUMMARY: A 72-year-old woman was referred to our hospital because her left eye had a corneal ulcer due topine needle trauma, and she did not respond to the initial therapy in a private clinic for 1 week. We first applied topical and systemic antibiotics. However, the lesion did not subside, and necrosis progressed in the stroma at the center of the cornea. On day 6 of admission, perforation was found at the center of the cornea, and we excised the necrotic tissue and performed bilateral pedicle conjunctival flap transposition. After the operation, an ischemic change was observed, and in the fourth week perforation occured at the center of the transplanted conjunctival flap. Because we considered it difficult to perform the transplantation of a conjunctival flap in the left eye, we performed autotransplantation on the corneal perforation in the left eye using conjunctival flap obtained through a pterygium excision in the right eye. After the operation, vascular ingrowth started from the edge of the flap, and there were no symptoms of inflammation, shrinkage, or necrosis of the flap. During the follow-up observation, the flap survived well without necrosis.