Clinical Manifestations and Prognostic Factors of Ocular Infection Associated with Orbital or Preseptal Cellulitis

Purpose@#We assessed the clinical manifestations and prognostic factors associated with ocular infection in patients diagnosed with orbital and preseptal cellulitis. @*Methods@#We enrolled 40 patients diagnosed with ocular infection accompanied by orbital and preseptal cellulitis between October 2015 and December 2021. We divided patients into the “treatment success group” (patients whose infection resolved) and the “treatment failure group” (patients whose infection worsened and required evisceration). Clinical characteristics, such as infection-related ocular findings and microbiological features, were analyzed retrospectively in both groups. Chi-square tests and logistic regression analyses were performed to identify prognostic factors associated with treatment failure. @*Results@#The mean age of patients was 72.8 ± 11.92 years, with 17 (42.5%) of them being male. Among the patients, 11 had bacterial infections, and 3 had fungal infections. In total, 6 (15%) and 34 (85%) patients were classified into the treatment success and failure groups, respectively. The chi-square test revealed a significant association between the treatment failure group and several clinical factors, such as low best corrected visual acuity (BCVA), the logarithm of the minimum angle resolution (logMAR) BCVA > 2, low intraocular pressure (IOP) 2, IOP < 5 mmHg, large size of the corneal lesion, and a prolonged duration of symptoms demonstrated significant association with treatment failure. Notably, hypopyon is an important prognostic factor for treatment failure.

Tear Neuromediators in Subjects with and without Dry Eye According to Ocular Sensitivity / 전남의대학술지

To investigate differences of tear neuromediators between subjects with and without dry eye (DE) depending on the ocular sensitivity. Thirty-one subjects with DE and 29 subjects without DE were recruited in this study. The eyes were stimulated by exposure to an irritating product applied to the periocular region. Both DE and non-DE subjects were divided into the high sensitivity and low sensitivity groups based on the degree of ocular sensitivity to ocular irritation. Baseline tear film break-up time (TBUT) and corneal staining score were examined, and tear samples were collected. The concentrations of the tear neuromediators, including nerve growth factor (NGF), serotonin, calcitonin gene-related peptide (CGRP), substance P, neuropeptide Y, and vasoactive intestinal peptide were measured using the enzyme-linked immune sorbent assay. The baseline neuromediator concentrations were compared between subjects with and without DE based on ocular sensitivity. In both DE and non-DE subjects, baseline TBUT was significantly lower in the high sensitivity group than in the low sensitivity group. In the high sensitivity group, baseline tear NGF levels were higher in subjects with DE than in those without DE. In the low sensitivity group, baseline levels of tear CGRP were lower in subjects with DE than in those without DE. Tear neuromediators associated with DE had differences in their concentrations depending on ocular sensitivity. In patients with DE, tear NGF levels increased with high ocular sensitivity to ocular irritation, whereas tear CGRP levels decreased with low ocular sensitivity.

Accuracy of Intraocular Pressure Measurements of Eyes with Therapeutic Contact Lenses after Vitrectomy

Purpose@#To evaluate the accuracy of intraocular pressure (IOP) measurements obtained by a rebound and non-contact tonometer in eyes with a therapeutic contact lens (CL) after vitrectomy. @*Methods@#In 60 eyes of 60 patients who underwent vitrectomy for vitreoretinal disease, IOP was measured using a rebound tonometer (iCare ic200®; IOPRT) and non-contact computerized air puff tonometer (CT-80, IOPNCT), before and after wearing a CL (Purevision2®, +0.0 diopter). The mean IOP of three consecutive measurements were analyzed, and a comparative analysis with IOP measured by a Goldman applanation tonometer (IOPGAT) was performed. @*Results@#The mean IOPRT without and with the CL was 12.55 ± 5.43 and 13.12 ± 5.13 mmHg, respectively, showing a statistically significant difference (p = 0.02) and strong positive correlation (r = 0.90, p < 0.001). The mean IOPNCT with and without the CL was 12.18 ± 3.24 and 12.17 ± 3.14 mmHg, showing no statistically significant difference (p = 0.17). The consistency with IOPGAT (12.57 ± 5.22 mmHg) was highest in IOPRT without the CL, followed by IOPRT with the CL, IOPNCT without the CL, and IOPNCT with the CL (intraclass correlation coefficients = 0.955, 0.945, 0.856, and 0.850, respectively). In addition, the rebound tonometer successfully measured IOP, regardless of whether the CL was worn; however, the non-contact tonometer failed to measure IOP in seven eyes without the CL and nine with the CL. No difference was observed according to intraocular tamponade type. @*Conclusions@#A rebound tonometer can be used as an alternative IOL measuring method in eyes for which it is difficult to use a Goldman applanation tonometer due to the postoperative presence of a therapeutic CL.

Comparison of Clinical Characteristics in Vogt-Koyanagi-Harada Disease between Patients with and without Prodromal Manifestations

Purpose@#To compare the clinical characteristics of Vogt-Koyanagi-Harada (VKH) disease between patients with and without prodromal manifestations. @*Methods@#We retrospectively reviewed the medical records of patients with VKH disease who were treated with systemic steroids. We grouped the patients into the incomplete type (36 eyes of 18 patients) and probable type (32 eyes of 16 patients) according to the presence of prodromal manifestations. We compared the following outcomes between groups: best-corrected visual acuity (BCVA), anterior chamber (A/C) cell, central foveal thickness (CFT), maximal subretinal fluid (SRF) height, choroidal thickness at baseline and 12 months after treatment, and recurrence rate. @*Results@#BCVA logarithm of the minimum angle of resolution (logMAR) significantly improved from 0.37 ± 0.26 at baseline to 0.09 ± 0.17 at 12 months in the incomplete type group (p < 0.05) and from 0.35 ± 0.24 at baseline to 0.10 ± 0.18 at 12 months in the probable type group (p < 0.05); BCVA did not significantly differ between groups. Choroidal thickness significantly decreased at 12 months after treatment, compared with one week after treatment, in both groups (p < 0.05); choroidal thickness did not significantly differ between groups. There were no significant differences in clinical factors between groups, including baseline A/C cell, CFT, maximal SRF height, and recurrence rate. @*Conclusions@#No associations were found between disease type and clinical outcomes (BCVA, OCT findings, and recurrence). These data suggested that categorization of disease according to prodromal manifestations has limited usefulness in terms of clinical outcomes of VKH disease.

Bilateral Corneal Edema After Inhalation of Spray Paint

Purpose@#To report a case of acute bilateral corneal edema after inhalation of spray paint.Case summary: A 47-year-old male presented with blurred vision in both eyes 12 hours after inhalation of spray paint. He had no history of ocular surgery or chronic ocular disease. The corrected visual acuity was 20/100 in the right eye and 20/40 in the left eye. An ocular examination revealed diffuse bullous changes in the epithelium and mild stromal edema in the cornea of both eyes. At one week after treatment with topical hypertonic solutions and corticosteroids, the visual acuity had improved to 20/20 and slit-lamp examination showed clear corneas without edema. @*Conclusions@#Inhalation of a chemical substance can lead to acute bilateral corneal edema, even without direct contact, but the lesion may resolve rapidly.

Infectious Keratitis Caused by Shewanella Putrefaciens

PURPOSE: We report a case of infectious keratitis caused by Shewanella putrefaciens in a patient after fishing. CASE SUMMARY: A 75-year-old male with no underlying disease other than hypertension was admitted to our hospital because of decreased visual acuity and congestion in his left eye for 2 weeks. At the first ophthalmic examination, the best-corrected visual acuity (BCVA) of the left eye was counting fingers. Slit lamp examination showed stromal infiltrates with 2.0 × 2.0 mm corneal epithelial defects, endothelial inflammatory plaques and 1 mm height hypopyon with severe inflammation in the anterior chamber. Bacterial culture tests were performed by corneal scraping, which were positive for Shewanella putrefaciens, followed by treatment with moxifloxacin and ceftazidime topical antibiotics. After 2 months of treatment, the BCVA of the left eye improved to 0.4 and the corneal lesion clinically improved with residual mild stromal opacity. CONCLUSIONS: Shewanella putrefaciens should be considered as a causal pathogen of infectious keratitis in patients after fishing. We report a case of infectious keratitis caused by Shewanella putrefaciens, which has never previously been reported in the Republic of Korea.

Short-term Clinical Outcomes of Scleral Fixation of Intraocular Lenses Using a Scleral Tunnel and Groove

PURPOSE: We evaluated the short-term clinical outcomes of patients who underwent modified scleral fixation of an intraocular lens (IOL) using a scleral tunnel and groove. METHODS: From June 2016 to May 2017, 34 eyes of 34 patients who underwent modified scleral fixation of an IOL using a scleral tunnel and groove were retrospectively studied. We evaluated the best-corrected visual acuity (BCVA), corneal endothelial cell density, intraocular pressure (IOP), spherical equivalent, and postoperative complications at 1 week, 1 month, 3 months, and 6 months after surgery. RESULTS: The BCVA was 0.85 ± 0.83 logarithm of the minimal angle of resolution (logMAR) before surgery and 0.38 ± 0.61 logMAR at 6 months (p = 0.001). The corneal endothelial cell count was 1,955.12 ± 217/mm2 and 1,852.59 ± 190/mm2, before and after surgery, respectively, which was not significantly different (p = 0.186). Postoperative complications occurred in eight eyes (23.5%); IOP elevation in one eye (2.9%), IOL tilt or decentration in two eyes (5.7%), optic capture in four eyes (11.4%), and cystic macular edema in one eye (2.9%). The spherical equivalent showed myopic changes after surgery and decreased significantly over time (p = 0.001). CONCLUSIONS: Modified scleral fixation of the IOL using a scleral tunnel and groove improved the BCVA, but did not significantly affect corneal endothelial cell loss. This procedure can be a good alternative to conventional scleral fixation of an IOL, which has advantages in shortened surgical time and easy surgical manipulation.

Association of the GSTM1 and GSTT1 Genes with Diabetic Retinopathy in the Korean Population

PURPOSE: To investigate the correlation between Glutathione-S-transferase (GST) genes and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (DM). METHODS: In this case-control study, 131 patients who were diagnosed with DR, 105 diabetic patients who did not have DR, and 45 nondiabetic controls were examined from January 2013 to November 2015. To analyze deletion of the GSTT1 and GSTM1 genes, polymerase chain reactions of DNA in a buffy coat from peripheral blood were performed via electrophoresis. RESULTS: There were no statistically significant differences in age, sex, or spherical equivalent between the 236 type 2 diabetic patients and the 45 normal controls (p > 0.05). In both univariate and multivariate analyses, the duration of type 2 DR was longer (p = 0.004, p = 0.013), and HbA1c was higher (p = 0.004, p = 0.007) in the DR group than in the non-DR group. Presence of a GSTM1 deletion is associated with a lower frequency of DR (p = 0.017, p = 0.012). CONCLUSIONS: Deletion of the GSTT1 gene is not associated with an increased risk of DR, whereas GSTM1 deletion is associated with a lower risk of DR in patients with type 2 DM in the Korean population. Additional studies with larger sample sizes and different types of GST genes are needed to confirm this study.

Management of Anterior Chamber Migration of Dexamethasone Intravitreal Implant

No abstract available.

Analysis of Clinical Manifestations and Prognostic Factors in Herpetic Endotheliitis

PURPOSE: We aimed to analyze the clinical features of herpetic endotheliitis and to investigate the risk factors for recurrence of herpetic endotheliitis and corneal decompensation. METHODS: The medical records of 58 patients (58 eyes) who were diagnosed with herpetic endotheliitis were retrospectively reviewed. Patients with a follow-up period of less than 6 months and a previous history of ocular inflammation were excluded from this study. We recorded visual acuity, intraocular pressure, central corneal thickness, and endothelial cell density on both initial and final visit, and recorded clinical findings of the anterior and posterior segments of the eye only on initial visit. Factors affecting the recurrence of herpetic endotheliitis and corneal decompensation were also analyzed. RESULTS: Among the 58 patients, 45 patients had disciform type endotheliitis, 11 patients had diffuse type, and 2 patients had linear type. There were no significant differences between final clinical manifestations according to subtype. 14 patients exhibited recurrence of herpetic endotheliitis. High intraocular pressure and high-grade anterior chamber cells were associated with the recurrence of herpetic endotheliitis. On multivariate analysis, the only risk factor for the recurrence of herpetic endotheliitis was high intraocular pressure. We found that 8 patients exhibited corneal decompensation, and high intraocular pressure, high anterior chamber cell grade, and a history of cataract surgery were associated with corneal decompensation. On multivariate analysis, the risk factors for corneal decompensation were high anterior chamber cell grade and cataract surgery history. CONCLUSIONS: For herpetic endotheliitis, the subtype did not affect the final records of clinical manifestation, and the only risk factor for the recurrence of herpetic endotheliitis was high intraocular pressure. Additionally, the risk factors of corneal decompensation were found to be high-grade anterior chamber cells and a history of cataract surgery. Initial examinations of clinical manifestation are important for the successful treatment of herpetic endotheliitis.

Comparison of Clinical Long-Term Outcomes with Two Types of One-Piece Aspheric Intraocular Lenses after Cataract Surgery

PURPOSE: To compare the clinical outcomes of glistening-free intraocular lens (IOL) and conventional 1-piece aspheric IOL in implanted in-the-bag. METHODS: After phacoemulsification performed by a single surgeon, 2 different IOLs were implanted: enVista MX60 (glistening-free 1-piece aspheric IOL) in 38 eyes (group A) and AcrySof IQ (conventional 1-piece aspheric IOL) in 46 eyes (group B). Glare symptom score (0-5) obtained by questionnaires, best corrected visual acuity (BCVA), Functional Acuity Contrast Test (FACT), posterior capsular opacity (PCO), glistening formation and spherical equivalent error were compared and analyzed preoperatively and 6 months and 12 months postoperatively. RESULTS: A statistically significant improvement of BCVA and contrast sensitivity postoperatively was observed in all groups. There was statistically significant increase of glistening in group B compared with group A. However, there was no significant difference of FACT scores of spatial frequency in A, B, C, D and E columns and glare symptom score (0-10) obtained by questionnaires 12 months after surgery. Spherical equivalent errors were -0.38 +/- 0.27 D and -0.36 +/- 0.28 D for groups A and B, respectively. PCO occurred in 2 eyes in group A and 4 eyes in group B. CONCLUSIONS: EnVista MX60 IOL showed less glistening formation than AcrySof IQ IOL, however, there was no significant difference in terms of vision quality such as BCVA, FACT and glare symptom score at 12 months postoperatively.

Changes in the Clinical Manifestations of Ocular Injuries Induced by Power Lawn Mowers

PURPOSE: To investigate changes in the clinical manifestations of ocular injuries induced by power lawn mowers. METHODS: In a retrospective study of 172 patients with ocular injuries induced by power lawn mowers in 2006, 2010, and 2014. Best corrected visual acuity (BCVA) at the time of presentation and 6 months after trauma, age, sex and seasonal distribution were analyzed. We assessed the degree of injury using slit lamp biomicroscopy, fundus examination, and computed tomography and analyzed the prognoses according to open/closed injury and, anterior/posterior segment injury. All patients underwent medical or surgical treatment, and the factors affecting final BCVA were analyzed. RESULTS: The ratio of closed injuries increased significantly (p = 0.027), as did the ratio of corneal erosion (p = 0.020), and, the ratio of corneal laceration decreased significantly (p = 0.014) over time. In the multivariate analysis, initial BCVA was the only risk factor of poor visual outcome in both open and closed injuries. CONCLUSIONS: The proportion of open globe injury has decreased over time. In contrast, the proportion of simple injuries such as corneal erosion has increased in ocular injuries induced by power lawn mowers. Lower initial visual acuity was the only risk factor of poor visual outcome in both open and closed injuries.

Long-Term Outcome of Treatment with Topical Corticosteroids for Severe Dry Eye Associated with Sjogren's Syndrome / 전남의대학술지

This retrospective study was performed to analyze the long-term outcome of topical corticosteroid treatment for severe dry eye associated with Sjogren's syndrome (SS). Patients who had severe dry eye associated with SS were topically treated with loteprednol etabonate 0.5% (group A, n=66) or fluorometholone 0.1% (group B, n=67) twice daily and were followed up for 2 years. Visual acuity (VA), intraocular pressure (IOP), Schirmer test, tear film breakup time (BUT), keratoepitheliopathy, and symptom scores were measured at baseline and 6, 12, 18, and 24 months after treatment. VA and IOP were not changed significantly during follow-up in either group. Schirmer test results, keratoepitheliopathy, and symptom scores at 6, 12, 18, and 24 months (p<0.05) and tear film BUT at 12, 18, and 24 months (p<0.05) significantly improved after treatment compared with baseline in both groups. No significant differences between the groups were found in any parameter during follow-up. At 24 months, the number of patients with IOP elevation of more than 2 mmHg compared with baseline was 4 in group A (6.1%) and 9 in group B (13.4%). The mean IOP in these patients was lower in group A than in group B (15.00+/-0.82 mmHg versus 16.50+/-1.12 mmHg; p=0.04). Long-term application of low-dose topical corticosteroids is effective for controlling signs and symptoms of chronic, severe dry eye associated with SS. Loteprednol etabonate 0.5% may have a lower risk for IOP elevation than fluorometholone 0.1%.

Long-Term Outcome of Treatment with Topical Corticosteroids for Severe Dry Eye Associated with Sjogren's Syndrome / 전남의대학술지

This retrospective study was performed to analyze the long-term outcome of topical corticosteroid treatment for severe dry eye associated with Sjogren's syndrome (SS). Patients who had severe dry eye associated with SS were topically treated with loteprednol etabonate 0.5% (group A, n=66) or fluorometholone 0.1% (group B, n=67) twice daily and were followed up for 2 years. Visual acuity (VA), intraocular pressure (IOP), Schirmer test, tear film breakup time (BUT), keratoepitheliopathy, and symptom scores were measured at baseline and 6, 12, 18, and 24 months after treatment. VA and IOP were not changed significantly during follow-up in either group. Schirmer test results, keratoepitheliopathy, and symptom scores at 6, 12, 18, and 24 months (p<0.05) and tear film BUT at 12, 18, and 24 months (p<0.05) significantly improved after treatment compared with baseline in both groups. No significant differences between the groups were found in any parameter during follow-up. At 24 months, the number of patients with IOP elevation of more than 2 mmHg compared with baseline was 4 in group A (6.1%) and 9 in group B (13.4%). The mean IOP in these patients was lower in group A than in group B (15.00+/-0.82 mmHg versus 16.50+/-1.12 mmHg; p=0.04). Long-term application of low-dose topical corticosteroids is effective for controlling signs and symptoms of chronic, severe dry eye associated with SS. Loteprednol etabonate 0.5% may have a lower risk for IOP elevation than fluorometholone 0.1%.

Long-Term Outcome of Treatment with Topical Corticosteroids for Severe Dry Eye Associated with Sjogren's Syndrome / 전남의대학술지

This retrospective study was performed to analyze the long-term outcome of topical corticosteroid treatment for severe dry eye associated with Sjogren's syndrome (SS). Patients who had severe dry eye associated with SS were topically treated with loteprednol etabonate 0.5% (group A, n=66) or fluorometholone 0.1% (group B, n=67) twice daily and were followed up for 2 years. Visual acuity (VA), intraocular pressure (IOP), Schirmer test, tear film breakup time (BUT), keratoepitheliopathy, and symptom scores were measured at baseline and 6, 12, 18, and 24 months after treatment. VA and IOP were not changed significantly during follow-up in either group. Schirmer test results, keratoepitheliopathy, and symptom scores at 6, 12, 18, and 24 months (p<0.05) and tear film BUT at 12, 18, and 24 months (p<0.05) significantly improved after treatment compared with baseline in both groups. No significant differences between the groups were found in any parameter during follow-up. At 24 months, the number of patients with IOP elevation of more than 2 mmHg compared with baseline was 4 in group A (6.1%) and 9 in group B (13.4%). The mean IOP in these patients was lower in group A than in group B (15.00+/-0.82 mmHg versus 16.50+/-1.12 mmHg; p=0.04). Long-term application of low-dose topical corticosteroids is effective for controlling signs and symptoms of chronic, severe dry eye associated with SS. Loteprednol etabonate 0.5% may have a lower risk for IOP elevation than fluorometholone 0.1%.

A Case of Chronic Osteomyelitis of the Orbit

PURPOSE: To report a case of chronic osteomyelitis of the orbit. CASE SUMMARY: A 61-year-old woman visited the ophthalmology clinic with a 3-month history of right periorbital swelling and pain. She had a history of ondontitis treated with oral antibiotics three months previously. A hard, tender, swollen mass was palpated near the right lower eyelid extending to the floor of the right orbit. Otherwise, there were no other clinically-specific ocular signs. Orbital computed tomography and bone scan findings suggested right periorbital soft tissue inflammation with underlying osteomyelitis of maxillar and zygomatic bones involving the inferior and lateral orbital walls. The patient was admitted and treated with broad spectrum systemic antibiotics. After 7 days, periorbital soft tissue swelling and pain were improved, but the size of the hard mass was unchanged. Seven days after admission, incision and drainage of the periorbital hard mass near the lower eyelid and debridement of the necrotic and pyogenic tissue were performed. Histologic examination showed chronic granulomatous inflammation and bony necrosis of the mass. The patient was discharged after receiving systemic antibiotics for 7 more days. At the 6-month follow-up, no recurrence or abnormal findings in the right periorbital region were observed. CONCLUSIONS: Chronic orbital osteomyelitis should be treated with combined systemic antibiotics and surgical intervention.

A Case of Peripheral Ulcerative Keratitis and Scleritis in a Patient with Pustular Psoriasis

PURPOSE: To report a case of peripheral ulcerative keratitis and scleritis in a patient with pustular psoriasis. CASE SUMMARY: A 62-year-old male presented with skin lesions on the hands and feet and pain in the right eye, which started a few days prior. Corrected visual acuity was 0.5 in the right eye and 0.7 in the left eye at initial visit. Corneal edema, erosion, ulcer and peripheral corneal infiltration of the right eye were observed. However, anterior chamber reaction was not observed. Histological analysis of hand skin lesions indicated pustular psoriasis. The patient was initially treated with topical antibiotics and a combined therapy of oral and topical steroids for ocular symptoms. As a result, the right eye showed slight improvement and the oral steroid was discontinued. One month after the initial visit, scleritis appeared on the left eye and topical and oral steroids were restarted for both eyes. Two months after the initial visit, ocular symptoms were improved significantly and corrected visual acuity was 1.0 in both eyes. The mild peripheral corneal opacity remained in the right eye, but the previous inflammations in both eyes were improved. CONCLUSIONS: As shown in this case, possibility of peripheral corneal infiltration, corneal ulcer and scleritis should be considered in patients with pustular psoriasis and topical and systemic steroids should be administered if accompanying ocular manifestations occur.

Higher Order Aberrations of the Corneal Surface after Laser Subepithelial Keratomileusis

PURPOSE: To evaluate the changes of higher order aberrations (HOAs) before and after laser subepithelial keratomileusis (LASEK) and to analyze the influence of tear film instability on HOAs of the corneal surface after LASEK. METHODS: In this cross-sectional study, 31 patients who underwent LASEK were divided into dry eye (16 patients, 32 eyes) and non-dry eye groups (15 patients, 30 eyes). Uncorrected distance visual acuity, spherical equivalent refraction, ablation depth, tear film parameters and Ocular Surface Disease Index (OSDI) questionnaire scores were evaluated in both groups. Total HOA root mean square (RMS), third-order coma, third-order trefoil and fourth-order spherical aberration (SA) of the corneal surface immediately and at 10 seconds after blinking were measured before and after surgery. RESULTS: The total HOA RMS, coma, trefoil and SA significantly increased after LASEK compared with preoperative values in both groups. In the dry eye group, total HOA RMS, coma and trefoil significantly increased except for SA at 10 seconds after blinking compared with those measured immediately after blinking. In addition, the changes of total HOA RMS, coma and trefoil were negatively correlated with tear film break-up time (R = -0.420, -0.473 and -0.439, respectively), but positively correlated with OSDI score (R = 0.433, 0.499 and 0.532, respectively). In the non-dry eye group, there were no significant differences between HOAs measured at 10 seconds after blinking and those measured immediately after blinking. CONCLUSIONS: The HOAs including coma, trefoil and SA significantly increased after LASEK. The tear film instability in the dry eye can be associated with more deterioration of the optical quality after LASEK, due to more significant increase of total HOA RMS, coma and trefoil.

Analysis of Factors Related of Location of Initial Visual Field Defect in Normal Tension Glaucoma

PURPOSE: To investigate the risk factors related to the location of visual field defects in normal tension glaucoma. METHODS: Eighty-one eyes diagnosed as normal tension glaucoma in patients with early glaucomatous visual field defects were divided into central visual field defects and peripheral visual field defects. The difference between the 2 groups based on the intra-individual comparison were assessed with several ocular risk factors such as sex, age, hypertension, diabetes mellitus, smoking, laterality, intraocular pressure, central corneal thickness, cup-disc ratio, peripapillary atrophy, mean deviation, pattern standard deviation, best corrected visual acuity, and refractive errors. RESULTS: The incidence of hypertension in the central visual field defects group (60.6%) was higher than in the peripheral visual field defects group (22.9%, p = 0.001). The central corneal thickness in the central group (533.1 +/- 18.2 microm) was thinner than in the peripheral group (545.0 +/- 30.0 microm, p = 0.003). Hypertension was the only risk factors for central visual field defects (p = 0.001). In both the central group and peripheral group, upper visual field defects were more common than lower defects. CONCLUSIONS: Hypertension in patients with normal tension glaucoma was a factor involved in central visual field defects. Additionally, numerous visual field defects were mainly found the superior portion.

The Clinical Manifestations and Treatment Results of Congenital Lacrimal Fistula

PURPOSE: To evaluate the clinical manifestations and the results of treatment in congenital lacrimal fistula. METHODS: We retrospectively evaluated the symptoms, associated anomalies, and results of treatment in patients with congenital lacrimal fistula. RESULTS: The mean age of the 22 total patients was 22.5+/-24.6 years (4 months~77 years). Associated anomalies were shown in two patients - one with hearing loss and upper punctal atresia, and the other with imperforate anus and undescended testes. Symptoms were tearing in 18 eyes and subcutaneous nodule in 3 eyes. Most of the external ostium of the fistula were located at the skin inferomedial (16 eyes) or medial (5 eyes) to the medial canthus, but one case had external ostium at the medial palpebral conjunctiva. Symptom improved in all patients after fistulectomy with bicanalicular intubation in 12 eyes, fistulectomy in 1 eye, bicanalicular intubation in 1 eye, and dacryocystorhinostomy combined fistulectomy with bicanalicular intubation in 2 eyes. However, the fistula recurred in 3 cases (19%). CONCLUSIONS: Lacrimal fistula is a congenital anomaly which can cause tearing or subcutaneous nodule. Treatment appropriate to the patient is required to get favorable result.