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.

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.

Corneal Endothelial Change After Intravitreal Bevacizumab Injection

PURPOSE: To evaluate the in vivo corneal endothelial changes after intravitreal bevacizumab (Avastin(R); Genentech Inc., San Francisco, California, USA) injection. METHODS: A total of 30 eyes of 28 patients who received intravitreal bevacizumab injections were included in the present study. Before injection and one and three months after injection, specular microscopy was performed to analyze the corneal endothelial cell changes. In order to compare the differences in the changes of corneal endothelial cells, the eyes were divided into two groups, a single injection group and a multiple injection group. RESULTS: The mean endothelial cell count decreased from 2,497.4 +/- 427.8 at baseline to 2,421.2 +/- 430.5 at one month and to 2,362.7 +/- 366.2 at three months after the injection in all patients. However, the change in endothelial cell count was not statistically significant. In addition, the postoperative change in endothelial cell count was more prominent in the multiple injection group than in the single injection group, although the difference was again not significant. No significant changes in preoperative or postoperative coefficients of variation for cell area or hexagonalities were observed in either patient group or within each group. CONCLUSIONS: There was no significant change in corneal endothelial cells after intravitreal bevacizumab injection. In addition, there was no significant difference in the changes in corneal endothelial cells according to the number of bevacizumab injections.

Effects of Hyaluronic Acid on the Polymorphonuclear Leukocyte (PMN) Release of Active Oxygen and Protection of Bovine Corneal Endothelial Cells from Activated PMNs

The goal of this study was to evaluate the function of hyaluronic acid (HA) on the active oxygen release from polymorphonuclear leukocytes (PMNs) and the protective effect of bovine corneal endothelial cells (BCEC) from activated PMNs. We used HA with three different molecular weights (MW 700, 000, 2, 000, 000, and 4, 000, 000) and five different concentrations (0, 0.1, 1, 2, and 3 mg/ml). We evaluated the amount of released superoxide from activated PMNs by using dismutase-inhibitable ferricytochrome C reduction. To compare the property and protective effect of HA with those of other viscoelastic substances, we used the same concentration of methylcellulose. HA suppressed superoxide release from PMNs and protected BCEC from activated PMNs in a dose-dependent, rather than a molecular weight-dependent, manner. The effect of HA reached almost a plateau at concentration above 2 mg/ml. However, methylcellulose, another viscoelastic substance, showed a similar effect. Therefore, it seems that the suppression of superoxide released from PMNs is not a property that is unique to HA, but is a general property of viscoelastic substances. Our results indicate that the action mechanism of HA proceeds not only through cell surface HA-receptor. We think that HA also acts as a physical barrier and/or a scavenger of superoxide.

Relationship between Dry Eye Syndrome and Hormone Replacement Therapy in Postmenopausal Women

PURPOSE: An investigation was carried out into the relationship between dry eye syndrome and hormone replacement therapy(HRT) in postmenopausal women METHODS: A retrospective analysis was made of the symptomatic differences between 100 and 25 postmenopausal women suffering from dry eye symptoms who had either undergone, or not, HRT, respectively. RESULTS: The average total time period of HRT in 57 of the patients was 41.4months, (ranging form 2 to 180 months) in 57 patients. 16 patients had received an estrogen only regimen, and 41 a combination therapy, consisting of both estrogen and progesterone. The Schirmer test results and the tear film break-up times(BUT) in these two groups were 7.29 +/- 4.29 and 6.59 +/- 4.64 mm, and 5.00 +/- 2.47 and 4.95 +/- 2.35 seconds, respectively. No significant difference in the results was found between the two groups. The Schirmer test and BUT results in the HRT patients averaged 6.75 +/- 4.50 mm, and 4.95 +/- 2.37 seconds, respectively. The results showed a statistically significant decrease (p<0.05) for the non-HRT patients, with Schirmer test and BUT results of 11.73 +/- 7.09 mm, and 8.65 +/- 4.50 seconds, respectively. CONCLUSIONS: The total time period and the type of HRT regimen had no influence on the severity of the dry eye symptoms in postmenopausal women. However, when compared to non-HRT patients, the degree of symptomatic manifestations showed statistically significant increases. Further observations and follow-up on these subjects should be pursued.

Corneal Ulcer and Chronic Conjunctivitis Due to Ofloxacin-resistant MRSA

PURPOSE: Considering popular use of fluoroquinolone eyedrops in Korea, it is important to know emerging resistant strain in treating infectious eye disease. We report methicillin resistant Staphylococcus aureus after frequent use of ofloxacin eyedrop in corneal ulcer and chronic conjunctivitis. METHODS: Four strains of ofloxacin-resistant MRSA (Methicillin-Resistant Staphylococcus Aureus) in patients with keratitis and conjunctivitis were found in our study. One strain was detected in a patient who used ofloxacin eyedrops intermittently for the treatment of recurrent corneal erosion which resulted from a bullous keratopathy after graft failure, and the others were detected in three patients using ofloxacin eyedrops intermittently or continuously for the treatment of conjunctivitis over 1 year. RESULTS: As fluoroquinolone eyedrop has been used more frequently, it is presumed that antibiotic resistance rate of ocular strains to ofloxacin might be increased. Therefore, a careful use of topical antibiotics based on the culture and antibiotic sensitivity test should be emphasized for the successful treatment of infectious ocular diseases.

The Longterm Evaluation of Recurrent Corneal Erosion

PURPOSE: It is known that the recurrent corneal erosion is a common disease, but its treatment is quite difficult. New concept of the pathogenesis of recurrent corneal erosion has emerged. And new therapeutic trial has been applied and its effect has been great. We review the trend of therapy to propose a new treatment modality of the disease. METHODS: Thirty-one patients who were diagnosed and treated for recurrent corneal erosion in ophthalmology department of our hospital from May.1994 to May. 2001. were selected. The distribution of age, sex, the causative factor of the disease, treatment modality, duration of therapy and the complication of disease in these patients were analyzed. RESULTS: The peak age of recurrent corneal erosion was 40s to 50s. The most common causes of recurrent corneal erosion were trauma, chronic use of eyedrops is also one of the causes of recurrent corneal erosion. The treatment includes simple eye patch (41.93%), therapeutic contact lens (22.58%) and excimer laser (35.48%). The mean duration of treatment was 10.2 days and recurrence rate was 15.94%. CONCLUSION: In conclusion, recurrent corneal erosion does have organic causative factors and the disease can be well-treated with conservative therapy such as simple patch and wearing of contact lens. The surgical techniques such as excimer laser therapy have also brought successful outcome in the patients with corneal erosions of more than 6 weeks'duration.

A Case of Ocular Sparganosis in Korea

PURPOSE: Ocular sparganosis has not been reported in Korea and 5 cases have been reported sporadically worldwide. Among these, 2 cases were found under the conjunctiva. We reported the first Korean case of ocular sparganosis manifesting as a subconjunctival mass. CASE: A 29-year-old man was presented to remove sunconjunctival mass in his left eye for cosmetic purpose. His ocular findings were normal except 0.5 x 0.5 mm sized subconjunctival mass. The surgically excised mass was suspected to have a parasite grossly. Sparganum was identified under microscopic examination after hematoxylin-eosin staining. CONCLUSIONS: The morphologic state of mumified parasite under microscope was plerocercoid phase of spargaum. His ocular movement and visual acuity remained normal after excision of the mass.

Serum factors associated with neovascular glaucoma following vitrectomy for proliferative diabetic retinopathy

We performed a retrospective study of serum factors associated with neovascular glaucoma that can occur following vitrectomy for proliferative diabetic retinopathy. The medical records of 183 patients (241 eyes) who received vitrectomy between August 1996 and August 2000 were studied retrospectively and subsequently analyzed by linear logistic regression analysis and multiple logistic regression tests. Neovascular glaucoma developed at an average of 2.7 months in 31 of 241 eyes (14.1%). The overall anatomical success rate of retinal attachment was 82.5% (199 eyes in 241 eyes), although it decreased to 45.1% (14 eyes in 31 eyes) in eyes with neovascular glaucoma. Serum cholesterol (P = 0.041) and fibrinogen levels (P = 0.020) were significantly associated with the development of neovascular glaucoma. However, no significant association could be found concerning hypertension, diabetic retinopathy or hypercholesterolemia (P > 0.05). We suggest that serum creatinine, cholesterol and fibrinogen levels can be used to predict the development of neovascular glaucoma in vitrectomized eyes with diabetic retinopathy and can further provide a more active approach to preventing the development of this condition.

Regression and its Mechanism after Laser In Situ Keratomileusis

We evaluated the degree and mechanism of regression after laser in situ keratomileusis[LASIK]on moderate to highly myopic eyes during the first postopserative 6 months. Betwwen January 1997 and October 1998, 61 eyes operated on with LASIK for myopia, with 2 diopter or more myopic regres-sion occuring during than first 6 months were included in this study. And 79 eyes in control group with less than 1 diopter were included. The attemped correction for refractive error was determined by cycloplegic refraction. We evaluated the changes of refractive error, uncorrected visual acuity, best corrected visual acuity, corneal topography, corneal thickness and keratometry before operation, one day, one week, two months and six months after operation. In regression group, corneal thickness was significantly incresed from 0.425 +/-0.048millimeter at postoperative 1 week to 0.444 +/-0.050millimeter postoperative 6 month[p=0.003]and central corneal power was significantly increased from 36.45 +/-2.03 dopter at 1 week to 37.45 +/-5.52 diopter.[p<0.01]The larger sperical equivalent and cylinder were, the more amount myopic regression was in contrast with control group. Early regression of refractive effect after LASIK appears to be a consequence of an increase in corneal thickness associated with central corneal steepening.