The Prospective Comparison of the Efficacy of Intermittent Atropine Penalization and Part-time Occlusion Therapy

PURPOSE: The objective of this study was to compare prospectively the efficacy between intermittent atropine penalization and part-time occlusion therapy for amblyopia in patients younger than 10 years old. METHODS: The patients with newly diagnosed amblyopia were randomly assigned to either atropine penalization (Group A) or occlusion therapy (Group O). One drop of atropine was instilled into the sound eyes of patients in group A twice per week, while each patient in group O underwent daily patching for 6 hours in their sound eyes. The minimum follow-up time was 3 months after treatment. Best corrected visual acuity and compliance were compared for both groups. RESULTS: A total of 43 patients were enrolled in this study, with 18 assigned to group A and 25 to group O. The follow-up period was not significantly different between group A and group O (6.3 and 7.0 months, respectively; p=0.437). The final corrected visual acuity (LogMAR) scores of amblyopic eyes in both groups showed significant improvement in the visual acuity of amblyopic eyes compared with that at baseline (0.28 in group A and 0.19 in group O). Group A had a higher level of compliance than group O (97.0 and 91.5%, respectively; p=0.007). There was no difference in the groups with regard to visual acuity in amblyopic eyes,which showed similar improvement (3.5:3.4 lines, respectively; p=0.867). CONCLUSIONS: This study shows that for treating amblyopia in children younger than 10 years old, intermittent atropine penalization seems to be as effective as part-time occlusion.

Clinical Analysis of Anisometropic Amblyopia with Monocular Vision 0.1 or Worse

PURPOSE: To analyze the results of treatment in pure anisometrpic amblyopia with unilateral visual acuity of 0.1 or worse. METHODS: The major eligibility criteria included pure anisometropic amblyopia with age <10 years, best-corrected visual acuity 0.1 or worse in the worse eye and 0.5 or better in the good eye after the wearing of optimal spectacle correction for a minimum of 4 weeks, and the minimum follow-up was 6 months. Twenty-one patients were selected and we analyzed the age at the amblyopia treatment, the type and degree of anisometropia, and the final visual acuity after treatment for visual improvement. Successful treatment was defined as a final visual acuity of 0.3 or more. RESULTS: The mean age at treatment was 5.2 years. The types of anisometropia were hypermetropic in 14 patients, astigmatic in 4, and myopic in 3. The mean duration of treatment of amblyopia was 16 months, and 13 of 21 children with pure anisometropic amblyopia achieved 0.3 or better. The age at treatment was younger and the compliance rate was higher in the success group than in the failure group. CONCLUSIONS: The most common type was hyperopic in the pure anisomteropic amblyopia. Compliance and age at treatment were significantly related to best visual acuity attained in pure anisometropic amblyopia with unilateral visual acuity of 0.1 or worse.

Fluorescein Angiographic Features in Central Retinal Vein Occlusion With and Without Optic Nerve Head Swelling

PURPOSE: To investigate the characteristics of fluorescein angiograms (FAG) of the optic nerve head and retina according to the presence of optic nerve head swelling (ONHS) in central retinal vein occlusion (CRVO). METHODS: The records of 69 eyes were reviewed, confirmed with the diagnosis of CRVO, and compared for several features according to the presence of ONHS. The best-corrected visual acuities and intraocular pressures were recorded and patterns of retinal hemorrhage were described. The presence of fluorescein filling defects of the optic disc, time till fluorescein started to fill at the optic disc, arteriovenous transit time, and nonperfused areas were assessed using FAG. RESULTS: Forty-one patients without ONHS (group 1) and 28 patients with ONHS (group 2) were included. The mean ages for groups 1 and 2 were 61.4 and 56.9 years, respectively, and there was no significant difference the mean ages between the groups. The fluorescein filling defect of the optic disc was seen more often in group 1 (n=13) than in group 2 (n=2). Marginal irregularity of the foveal avascular zone due to perifoveal capillary drop out was seen significantly more often in group 1 (n=12) than in group 2 (n=2). CONCLUSIONS: Fluorescein filling defects of the optic disc and perifoveal capillary drop out were more frequently seen in CRVO patients without ONHS. However, longitudinal studies are needed to confirm the prognostic value of ONHS and the correlation of filling defects with progressive optic neuropathy in CRVO.

Isolated Langerhans Cell Histiocytosis in the Palpebral Conjunctiva of an Adult Patient

PURPOSE: To report a case of isolated Langerhans cell histiocytosis (LCH) in the palpebral conjunctiva of an adult patient. METHODS: A 39-year-old male presented with a mass of one month's duration on the palpebral conjunctiva of his left upper lid. The lesion had gradually progressed. The mass was non-tender, relatively well circumscribed, yellowish white, flat, firm, and 5 mm x 8 mm in size. Otherwise, the ophthalmic examination was completely normal, including the anterior and posterior segments. Based on the clinical picture, an infiltrative/neoplastic lesion was suspected. Incision biopsy was performed to obtain a diagnosis for proper management. RESULTS: The histopathologic examination of the lesion showed an intensive proliferation of monotonous and histiocytoid cells beneath the epidermis. Immunohistochemical study revealed that the tumor cells were positively stained in the cytoplasm with anti CD1A antibody and anti S-100 antibody. The patient was then referred to the Oncology Department for evaluation. A detailed systemic examination, and the laboratory and radiologic investigations ruled out systemic involvement. The diagnosis of isolated LCH was finally made. Three months later, the lesion underwent remission without any treatment. CONCLUSIONS: This rare disorder may also present as a solitary lesion on the palpebral conjunctiva in adults, and so it should be kept in mind during the differential diagnosis of a conjunctival mass in an adult.

Clinical Analysis of Reoperation for Strabismus after Strabismus Surgery in Childhood

PURPOSE: To report the clinical characteristics of patients undergoing reoperation after strabismus surgery during childhood. METHODS: Sixty-one patients who had undergone strabismus surgery in childhood and later reoperation were included. Age, visual acuity, type of strabismus at the first and second operations and postoperative angle of deviation were analyzed. The causes of reoperation were classified into recurrent, consecutive, or newly developed strabismus. Recurrent strabismus was defined as strabismus developed in the same direction after correction within 10 prism diopters (PD). Consecutive strabismus was defined as strabismus developed in the opposite direction after surgical overcorrection. RESULTS: The mean duration between the first operation and reoperation was 5.6 years. Recurrent exotropia was the most common cause of reoperation. The incidence of vertical strabismus was higher in reoperations than in first operations (4.9 vs 26.2%, P=0.020). Most incidences of vertical strabismus in the reoperation were newly developed after first operation for horizontal strabismus. At the last follow-up, 63.9% had ocular alignment within 10PD in the horizontal plane and within 8PD in the vertical plane. The frequency of amblyopia was 16.4%. CONCLUSIONS: Recurrent exotropia was the most common cause of reoperation for strabismus. The incidence of vertical strabismus was higher in reoperations than in first operations.

Cytomegalovirus Retinitis in a Child with Acute Lymphoblastic Leukemia

PURPOSE: To report a case of cytomegalovirus (CMV) retinitis in a child who had been managed by immunosuppressive chemotherapy for acute lymphoblastic leukemia (ALL). METHODS: An 8-year-old boy who had been managed by immunosuppressive chemotherapy for ALL was referred to the ophthalmologic clinic because of blurred vision in his right eye. Fundus examination showed hard exudates and white retinal leaion in the macular area of the right eye, white retinal lesion accompanied with retinal hemorrhage and exudates in the midperipheral retina of the left eye. Serologic tests demonstrated a positive response of CMV antibody IgG and a negative response of CMV antibody IgM. CMV was isolated upon the culture of bone marrow and peripheral blood. Immunosuppressive chemotherapy was discontinued and ganciclovir was administered. RESULTS: Administration of ganciclovir led to clinical stabilization of the retinitis lesion that was accompanied by scarring. We were able to discontinue the administration of ganciclovir after the retinal lesions were resolved, and no recurrence of CMV retinitis was noted. CONCLUSIONS: Ganciclovir treatment was clinically effective in improving CMV retinitis in an immunocompromised child with ALL. In addition, the improved systemic immune function achieved by discontinuing immunosuppressive chemotherapy permitted discontinuation of anticytomegalovirus therapy.

The Effect of Fresnel Prism Treatment in Consecutive Esotropia

PURPOSES: To investigate the effect of Fresnel prism treatment in patients with consecutive esotropia after the surgery of exotropia. METHODS: Eighteen patients who have failed alternating occlusion therapy at least 1 month for consecutive esotropia without limitation of ocular motility following surgery for an exotropia were managed with Fresnel prism for esotropia associated with diplopia. The Fresnel prismatic power was selected to solve the diplopia and was changed in accordance with the degree of esodeviation during the follow up period. The surgical correction was performed in the case with increase of esodeviation in spite of the Fresnel prism therapy for 6 months or more. The angle of deviation and diplopia before and after the Fresnel prism therapy were investigated. RESULTS: The mean age at surgery for an exotropia was 7.8 years. The Fresnel prism therapy was performed at 4.2 months after exotropia surgery to solve esotropia in average 15.4 prism diopters (PD) at distance and 14.8PD at near. Of the 18 patients 11 (61.1%) had a successful outcome after average 14.8 months, i.e. 8PD or less of esodeviation, with relief of diplopia without the Fresnel prism. Two patients used the Fresnel prism to solve diplopia associated with esodeviation of 8PD or less. Five patients had esodeviation with 10PD or more and 2 of them were eventually needed a operation for esotropia. CONCLUSIONS: The Fresnel prism treatment is an effective device in treating diplopia as well as decreasing the frequency of surgery for esotropia in consecutive esotropia with diplopia.