Transscleral Cyclopexy Using Partial-Thickness Scleral Flap for Repairing Cyclodialysis Cleft: a Case Report

PURPOSE: To report a case of a cyclodialysis cleft that was successfully managed with gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap. CASE SUMMARY: A 44-year-old man complaining of blurred vision in the left eye after blunt trauma was referred to our hospital. The intraocular pressure (IOP) was 4 mmHg and the visual acuity was counting finger. Gonioscopy examination revealed cyclodialysis cleft from 3 to 6 o'clock and fundus examination revealed macular folds. After the failure of conservative medical therapy and laser photocoagulation, gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap was performed. Four months later, the IOP was 18 mmHg, the visual acuity was 0.8, and fundus examination showed the disappearance of the macular folds. CONCLUSIONS: Transscleral cyclopexy using partial-thickness scleral flap is a safe and effective method to treat hypotony maculopathy due to cyclodialysis and to minimize pupil distortion.

Clinical Features of Amblyopic Children with Myopic Anisometropia at a Tertiary Center

PURPOSE: To evaluate the clinical features of unilateral amblyopia with myopic anisometropia at a tertiary center. METHODS: The medical records of 102 children wearing spectacles due to myopic anisometropia with an interocular difference in spherical equivalent (SE) ≥ 1.00 diopters (D) with a follow-up ≥ 1 year were reviewed. Patients were classified into mild or severe groups according to an interocular SE difference ≥ 3.00D. The frequency of amblyopia (interocular difference ≥ two lines of visual acuity [VA]) and response to patching, the magnitude of anisometropia, and the frequency of combined ocular or systemic disorders except refractive errors were compared between the two groups. The VA and refractive errors were measured four months and one year after spectacle correction and at the last follow-up. RESULTS: In all, 61 patients with mild myopic anisometropia and 41 patients with severe myopic anisometropia started to wear spectacles at a mean age of 5.2 years old and were followed-up during a mean period of 34.6 months. The frequency of amblyopia decreased more prominently in the mild group: 82.0% in the mild group vs. 92.7% in the severe group four months after spectacle correction and 45.9% in the mild group vs. 87.8% in the severe group at the last follow-up. At baseline, the mild group had anisometropia of 1.42 ± 0.66D, while the severe group had anisometropia of 5.47 ± 2.09D. The magnitude of anisometropia tended to increase by 0.42D but not significantly: +0.78D in the mild group and −0.02D in the severe group. More than half of the patients had combined disorders: 57.4% in the mild group and 53.7% in the severe group. CONCLUSIONS: Severe myopic anisometropic amblyopia at a tertiary center showed little improvement and the magnitude of anisometropia did not change.

Smartphone Fundus Photography in an Infant with Abusive Head Trauma

PURPOSE: To report fundus photography using a smartphone in an infant with abusive head trauma. CASE SUMMARY: An 8-month-old male infant presented to the emergency room with decreased consciousness and epileptic seizures that the parents attributed to a fall from a chair. He had no external wounds or fractures to the skull or elsewhere. However, computerized tomography of the brain revealed an acute subdural hematoma in the right cranial convexity and diffuse cerebral edema, leading to a midline shift to the left and effacement of the right lateral ventricle and basal cistern. The attending neurosurgeon promptly administered a decompressive craniectomy. Immediately after the emergency surgery, a fundus examination revealed numerous multi-layered retinal hemorrhages in the posterior pole extending to the periphery in each eye. He also had white retinal ridges with cherry hemorrhages in both eyes. We acquired retinal photographs using the native camera of a smartphone in video mode. The photographer held the smartphone with one hand, facing the patient's eye at 15–20 cm, and held a 20 diopter condensing lens at 5 cm from the eye in the other hand. Our documentation using a smartphone led to a diagnosis of abusive head trauma and to obtain the criminal's confession, because the findings were specific for repetitive acceleration-deceleration forces to an infant`s eye with a strong vitreoretinal attachment. CONCLUSIONS: This ophthalmic finding had a key role in the diagnosis of abusive head trauma. This case presented the diagnostic use of a smartphone for fundus photography in this important medicolegal case.

Comparison of Intraocular Lens Calculation Formulas Measured by Immersion-Type A-Scan Ultrasound and Partial Coherence Interferometry

PURPOSE: To report the accuracy of intraocular lens (IOL) formulas according to axial length, anterior chamber depth, and mean corneal curvature when performing biometry with an immersion type A-scan with mannual keratomery and an IOL Master®. METHODS: Retrospective medical chart reviews were carried out for 82 eyes of 65 patients who underwent cataract surgery performed by a single surgeon. Biometry was performed using IOL Master®, mannual keratometry, and immersion type A-scan ultrasound in sequence. Prediction diopter was obtained using Sanders-Retzlaff-Kraff/Theoretical (SRK-T) and Holladay 1 formulas calculated with the biometric value measured by mannual keratomery and A-scan, and using SRK-T and, Holladay 2 formulas with IOL Master®. The final refractive outcome was determined as manifested refraction at least 7 weeks after the surgery, and it was compared with the preoperative prediction dipoter (D) of the IOL formulas. RESULTS: Mean axial length and mean keratomtric measurements as determined by A-scan with mannual keratomery showed significant statistical differences from those of IOL Master®. However, there was no difference in postoperative mean absolute error between biometric measurements, or among formulas according to axial length, anterior chamber depth, or mean corneal curvature. However, the percentage of actual refraction within ±0.50 D of the intended refraction was dirrerent among the four formalas according to axial length, anterior chamber dept, mean corneal curvature. CONCLUSIONS: Biometry measurement using the immersion-type A-scan with mannual keratomery is as accurate as that using IOL Master® for predicting the postoperative refractive state of cataract surgery. However, it is suggested that the best IOL formula be chosen according to axial length, anterior chamber depth, and mean corneal curvature.

The Effect of Single Hemodialysis to Nerve Conduction in Patients with Chronic Renal Insufficiency

We studied 16 uremic out-patients in terms of motor nerve conduction velocity (MNCV) and sensory latency, who had ungergone hemodialysis regularly at Maryknoll Hospital, Busan for 5 months, from Dec. 1982 to Apr. 1983. We checked, before and after single hemodialysis, MNCV of median, ulnar, peroneal, and posterior tibial nerves along with sensory lateny of median and ulnar nerves. We got the following as a result. 1. MNCV, before and after hemodialysis, was 47.2 +/- 4.6 m/sec to 50.0+/-2.6 m/sec (p 0.05) in median nerve, 50.0 +/- 4.5 m/sec to 52.4 +/- 3.2 m/sec (p 0.05) in ulnar nerve, 43.0 +/- 5.4 m/sec to 41.1 +/- 4.2 m/sec (statistically not significant) in peroneal nerve, and 41.5 +/- 4.8 m/sec to 43.8 +/-3.9 m/sec (statistically not significant) in posterior tibial nerve. It was pointed out that MNCV in particular of median and ulnar nerves increased. 2. Sensory latency, before and after hemodialysis, was 4.5+/-0.6 m/sec to 3.9+/-0.4 m/sec (p 0.05) in median nerve and 4.7 +/-0.9 m/sec to 4.0 +/- 0.3 m/sec (p 0.01) in ulnar nerve. This showed that sensory latency of median and ulnar nerves decreased significantly. 3. The serum concentration of BUN and creatinine, before and after hemodialysis, was, on an average, 97.8 +/- 18.2 mg/dl (50.7-136.7) to 34.4 +/- 9.5 mg/dl (7.9-20.1 mg/dl) and 14.8 +/- 3.2 mg/dl (7.7-20.1 mg/dl) to 6.2 +/- 1.7 mg/dl (2.4-8.6mg/dl) in each. This showed marked decreased after hemodialysis in serum concentration but meant no correlation with MNCV and sensory latency.