A Case of Bilateral Senile Scleral Hyaline Plaques

PURPOSE: To report a case of bilateral scleral hyaline plaques in an elderly male patient. Scleral hyaline plaques are commonly noticed but rarely diagnosed. These are typical areas of hyalinization over the insertions of horizontal rectus muscle. CASE SUMMARY: A 75-year-old man presented to the hospital complaining of scleral color change. External examination of both eyes revealed oval, slate-gray lesions measuring approximately 3.5 mm in diameter, located just anterior to the insertion of the medial rectus muscle in both eyes. On anterior segment optical coherence tomography of the lesions, thinned sclera and plaque were observed. There was no change in the lesion on the 3-year follow-up visit.

Reoperation after Photorefractive Keratectomy

Reoperation of Photorefractive keratectomy(PRK) may be considered for regression, corneal haze, topographic irregularity, and a combination of these complications. We have studied the results of reoperation after myopic PRK in 113 eyes. Between 1992 and 1994, we observed 3,053 eyes of 1,583 patients who underwent PRK over year follow-up. We analysed 113 eyes which showed regression with or without opacity and underwent reoperation over one year follow-up. For reoperation, we used the VixX Twenty/Twenty excimer laser. Of the 72 eyes on regression, 53 eyes(73.6%) showed successful result(spherical equivalent within +/-1.0D), but 19 eyes(24.6%) showed repeated regression after the reoperation. Of the 33 eyes with corneal opacity and regression, 14 eyes(42%) showed good results. Of the 8 eyes with a central island, the results was good in all of the cases. No complications were observed. In conclusion, the reoperation rate was 3.7%(113/3053). The main cause of reoperation was regression, and the best result of reoperation was central island. 75 eyes out of 113 eyes(66%) showed good results(spherical equivalent within +/-1D). Reoperation may be considered for regression with or without corneal haze and central island in PRK.

Detection of Eosinophil in Patient with Allergic Conjunctivitis by Impression Cytology

Allergic conjunctivitis is commonly encountered in the office parctice of ophthalmology. However, diagnosis is not easy because allergic conjunctivitis shows nonspecific ocular symptoms and signs. And for accurate diagnosis, conjunctival scraping for eosinophils, tear levels of specific IgE, skin testing to aeroallergens, and ocular challenge with allergens are available but these methods are much time and cost consuming. So we evaluate the usefulness of the detection of eosinophils by conjunctival impression cytology. Conjunctival impression cytology was done on 44 eyes of 44 patients who were diagnosed as allergic conjunctivitis. 7 eyes of 7 normal subjects and 14 eyes of 14 patients with epidemic keratoconjunctivits were used as control. Scoring system was defined according to the past history, symptom, sign, and slit lamp finding ranged from +1 to +5. Eyes of score +1 or +2 were defined as allergy suspect group, and eyes of score +3 to +5 defined as allergy group. The sensitivities of the impression dytology were 59% in allergy suspect group, 86% in definite allergy group and 72%in total, The specificity was 95%. According this study, we conclude that impression cytology is a simple, non-invasive and cheap method with high sensitivity and specificity for the diagnosis of allergic conjunctivitis.

Clinical Studies on the Relation of HLA B-27 and Uveitis

It is well known that the incidence of anterior uveitis is about 20-40% in HLA B-27 associated joint diseases, and especially common in male between the ages of 20 and 40. However, there is no study of the epidermiology and clinical features of it in Korea. The authors studied to know the incidence and clinical feature of uveitis in HLA B-27 associated joint diseases in Korea. We reviewed the records of 543 patients with HLA B-27 associated joint diseases, visited our rheumatoid center from March 1991 to August 1996. All patients were subjected to routine laboratory examinations; i.e., blood cell count, erythrocyte sedimentations rate, C reactive protein, rheumatoid factor, anti-nuclear antibody, and x-ray of the lumbosacral spine & sacro-iliac joints. 462 patientsout of 543 patients with HLA B-27 associated joint diseases had spondyloarthropathy. Anterior uveitis occurred in 32 patients (6.9%) among these 462 spondyloarthropathy patients. Clinical characteristics of the uveitis were male predominant (23/32) anterior uveitis (32/32), and unilateral (31/32).

Two Cases of True and Pseudo-internuclear Ophthalmoplegia with Bilateral Exodeviation

Internuclear ophthalmoplegia(INO) is characterized by the adduction deficit on lateral gaze associated with dissociated nystagmus of an abducting eye and caused by the lesion in the medial longitudinal fasciculus(MLF). It occurs unilaterally or bilaterally in infarction of brain stem and multiple sclerosis. Ocular myasthenia is a localized form of myasthenia involving extraocular, levator palpebrae perioris, and/or orbicularis oculi muscles. It is frequently confused with a variety of ocular mortility disorders including INO. We experienced 2 patients who had bilateral wall-eyes and diplopia. One was a true bilateral INO due to hypertensive brain stem infarction(Wall-eyed bilateral INO) and the other was a myasthenic bilateral pseudo-INO. Diagnosis was made by Tensilon test, repetitive nerve stimulation test of orbicularis oculi muscles, and serum antibody assay in latter case.