Analysis of Office Probing in Children Under 4 Years of Age with Congenital Nasolacrimal Duct Obstruction

Purpose@#To analyze the effect of office-based probing in different age groups of children with congenital nasolacrimal duct obstruction. @*Methods@#A retrospective study was conducted in 146 children (200 eyes) diagnosed with congenital nasolacrimal duct obstruction who underwent office-based probing. The children were classified into four groups at the time of probing: group A ( 6 months but 12 months but 20 months but < 48 months). Age at the time of the procedure, gender, laterality, follow-up period, clinical symptoms, and the number of probings were investigated. Success rates were compared among the four groups in terms of sex, age, laterality, and the number of probings. @*Results@#The success rate of the first probing was 160/200 eyes (80.0%). The success rates were 87.5% in group A, 85.7% in group B, 77.6% in group C, and 76.7% in group D. No significant difference in the success rate was observed according to age (p = 0.550). The second probing was performed in 40 eyes. The success rates were 100% in group A, 87.5% in group B, 70.6% in group C, and 35.7% in group D. A significant difference in the success rate was observed according to age (p = 0.048). The success rate of the second probing was 25/40 eyes (62.5%). No significant difference in laterality was observed among the four groups (p = 0.291). @*Conclusions@#No significant difference in the success rate of first nasolacrimal duct probing was detected, but a significant difference in the success rate of the second probing was detected according to age in children < 4 years of age.

Analysis of Office Probing in Children Under 4 Years of Age with Congenital Nasolacrimal Duct Obstruction

Purpose@#To analyze the effect of office-based probing in different age groups of children with congenital nasolacrimal duct obstruction. @*Methods@#A retrospective study was conducted in 146 children (200 eyes) diagnosed with congenital nasolacrimal duct obstruction who underwent office-based probing. The children were classified into four groups at the time of probing: group A ( 6 months but 12 months but 20 months but < 48 months). Age at the time of the procedure, gender, laterality, follow-up period, clinical symptoms, and the number of probings were investigated. Success rates were compared among the four groups in terms of sex, age, laterality, and the number of probings. @*Results@#The success rate of the first probing was 160/200 eyes (80.0%). The success rates were 87.5% in group A, 85.7% in group B, 77.6% in group C, and 76.7% in group D. No significant difference in the success rate was observed according to age (p = 0.550). The second probing was performed in 40 eyes. The success rates were 100% in group A, 87.5% in group B, 70.6% in group C, and 35.7% in group D. A significant difference in the success rate was observed according to age (p = 0.048). The success rate of the second probing was 25/40 eyes (62.5%). No significant difference in laterality was observed among the four groups (p = 0.291). @*Conclusions@#No significant difference in the success rate of first nasolacrimal duct probing was detected, but a significant difference in the success rate of the second probing was detected according to age in children < 4 years of age.

Bilateral Central Retinal Vein Occlusion in a Patient with Takayasu Arteritis

Purpose@#We report bilateral central retinal vein occlusion in a patient with Takayasu arteritis.Case summary: A 52-year-old female with hypertension complained of decreased vision in both eyes. The best-corrected visual acuities (BCVAs) were 0.2 in the right eye and 0.15 in the left eye. Fundus examination and optical coherence tomography revealed dilated and tortuous retinal veins, many flame-shaped hemorrhages, and macular edema in both eyes. We diagnosed central retinal vein occlusion in both eyes. Neck ultrasonography and computed tomography/angiography revealed Takayasu arteritis with near-total occlusion of the left common carotid artery, external carotid artery, and subclavian artery. We prescribed oral azathioprine and three monthly intravitreal injections of bevacizumab (Avastin®; Genentech, Inc., South San Francisco, CA, USA, 1.25 mg/0.05 mL). After 6 months of treatment, the retinal hemorrhage and macular edema disappeared and the BCVAs improved to 0.6 in the right and 0.8 in the left eye. @*Conclusions@#When encountering a case of bilateral central retinal vein occlusion, assessment of systemic vascular occlusive diseases such as Takayasu arteritis may be required.

Bilateral Central Retinal Vein Occlusion in a Patient with Takayasu Arteritis

Purpose@#We report bilateral central retinal vein occlusion in a patient with Takayasu arteritis.Case summary: A 52-year-old female with hypertension complained of decreased vision in both eyes. The best-corrected visual acuities (BCVAs) were 0.2 in the right eye and 0.15 in the left eye. Fundus examination and optical coherence tomography revealed dilated and tortuous retinal veins, many flame-shaped hemorrhages, and macular edema in both eyes. We diagnosed central retinal vein occlusion in both eyes. Neck ultrasonography and computed tomography/angiography revealed Takayasu arteritis with near-total occlusion of the left common carotid artery, external carotid artery, and subclavian artery. We prescribed oral azathioprine and three monthly intravitreal injections of bevacizumab (Avastin®; Genentech, Inc., South San Francisco, CA, USA, 1.25 mg/0.05 mL). After 6 months of treatment, the retinal hemorrhage and macular edema disappeared and the BCVAs improved to 0.6 in the right and 0.8 in the left eye. @*Conclusions@#When encountering a case of bilateral central retinal vein occlusion, assessment of systemic vascular occlusive diseases such as Takayasu arteritis may be required.

A Removed Chestnut Thorn after Corneal Incision

PURPOSE: To report the surgical technique to remove a chestnut thorn through a corneal incision. CASE SUMMARY: A 54-year-old female visited our clinic complaining of a sudden foreign body sensation and conjunctival injection in her left eye after picking chestnuts 4 days prior to her visit. Visual acuity of both eyes was 1.0 and the intraocular pressures were within normal limits. Slit lamp examination revealed that a chestnut thorn had deeply penetrated the left corneal stroma and a small number of inflammatory cells were observed in the anterior chamber. There was no corneal defect stained with fluorescein and the Seidel test was negative. A corneal foreign body comprised of a chestnut thorn and its remnants was diagnosed and emergency surgery was performed. A partial corneal incision was made along the foreign body and the exposed foreign body was easily and completely removed. The patient was treated with topical antibiotics after surgery and no complication was observed during a follow-up period of 3 months. CONCLUSIONS: In the case of a corneal foreign body comprised of a chestnut thorn, the foreign body with its remnants were easily removed by performing a partial corneal incision.

A Case of Punctate Inner Choroidopathy Followed by Multiple Evanescent White Dot Syndrome

PURPOSE: To report a delayed onset of multiple evanescent white dot syndrome in a patient with punctate inner choroidopathy. CASE SUMMARY: A 23-year-old female complained about sudden visual loss in the right eye. Best-corrected visual acuity (BCVA) was 20/100 in the right eye and 20/20 in the left eye. In fundus examination and optical coherence tomographic images, subfoveal choroidal neovascularization (CNV) with hemorrhage was observed in the right eye, accompanied by multiple lesions of atrophic pigmentation on the posterior pole in both eyes. We diagnosed the patient as punctate inner choroidopathy (PIC) and CNV in the right eye, and treated her using three monthly intravitreal injections of bevacizumab (Avastin®, Roche, Basel, Switzerland; 1.25 mg/0.05 mL). The CNV regressed and the BCVA improved to 20/20. Two years later, she complained of visual impairment in her left eye. The BCVA was 20/40. Fundus photography revealed numerous small white dots around the posterior pole and optic disc. Disruption of the photoreceptor layer was seen in optical coherence tomography images. Small white dots were observed as multiple hyperfluorescent dots in fluorescein angiography and hypofluorescent spots in indocyanine green angiography. An enlarged blind spot was observed in the visual field. We diagnosed her as multiple evanescent white dot syndrome (MEWDS). One month after systemic steroid treatment, the multiple white dots disappeared and the BCVA improved to 20/20. CONCLUSIONS: We determined that PIC and MEWDS, which belong to the white dot syndrome, could occur in a patient at different times.

Ocular Findings in Mucolipidosis Type II

PURPOSE: To report ocular findings of a mucolipidosis type II patient with novel mutation. CASE SUMMARY: A 10-year-old boy visited our pediatric genetic metabolic clinic for evaluation of his overall developmental delay and short stature. The boy was diagnosed with mucolipidosis type II (I-cell disease) using plasma enzyme assay and DNA sequencing of the GNPTAB gene mutation. An ophthalmologic investigation was then performed, and a depressed nasal bridge, broad nose, and swelling in the upper lid of both eyes were noted. The best corrected visual acuity was 0.32 and 0.1 and the intraocular pressure was 35 mmHg and 24 mmHg in the right and left eyes, respectively. The anterior chamber angles of both eyes were normal and mild cornea opacity in both eyes was observed. Fundus examination revealed retinal atrophy with folds in both eyes, as well as optic disc edema and optic atrophy in the right and left eyes, respectively. Atherosclerotic changes in the retinal vessels and cystoid macular edema in the left eye were observed, and ocular ultrasound revealed increased posterior sclera thickness in both eyes. CONCLUSIONS: Ocular manifestations of mucolipidosis type II are not currently well-known, and differentiation from other metabolic disorders may be difficult. An ophthalmic work-up can assist in diagnosis, and regular ophthalmic examinations should be used to maintain visual function in mucolipidosis patients.

Fitting the Miniscleral Contact Lens in Patients with Corneal Abnormalities

PURPOSE: To evaluate the clinical results of fitting the miniscleral contact lens (MSD; Happy Vision Corp., Anyang, Korea) in patients with corneal abnormalities. METHODS: Thirty-eight patients (56 eyes) fitted with MSD lenses were recruited for this study. Clinical indication, visual acuity, degree of comfort, mean wearing time, parameters of the finally prescribed lenses, number of fittings with trial lenses, success rate with the first prescribed lens, and adverse events were evaluated. RESULTS: Forty-two (75%) of 56 eyes were enrolled in this study due to keratoconus. Other conditions included Stevens-Johnson syndrome (6 eyes, 11%), high postkeratoplasty astigmatism (3 eyes, 5%), corneal scarring (3 eyes, 5%), and ectasia after laser in situ keratomileusis (LASIK; 2 eyes, 4%). The mean log MAR visual acuity improved from 1.01 ± 0.64 to 0.13 ± 0.19 after wearing lenses (p= 0.0001). In 53 eyes (94.6%), patients reported the miniscleral contact lenses to be comfortable, and the mean daily wear time was 12.9 ± 2.5 hours. The mean sagittal depth of finally prescribed lenses was 4.67 ± 0.37 mm (3.7-5.4). An average of 3.3 ± 1.5 (1-7) trials were needed for the trial fitting, and the average number of re-prescriptions to achieve the optimal fitting was 1.5 ± 0.48 (1-3). One patient discontinued the lenses after 3 months due to discomfort. CONCLUSIONS: Miniscleral contact lenses are a good alternative for patients with corneal abnormalities and result in both successful visual outcome and comfort.