Surgical Results of Repeated Trabeculectomy in Congenital Glaucoma

PURPOSE: To investigate the surgical results of repeated trabeculectomy in primary congenital glaucoma. METHODS: The authors retrospectively reviewed the data of 16 patients (23 eyes) who underwent two or more trabeculectomies with or without mitomycin C for primary congenital glaucoma between 1990 and 2004. Surgical success rate and postoperative complications were assessed. The relationship between the use of mitomycin C and the surgical outcomes was also studied. RESULTS: Among the 23 eyes, 10 had a history of previously failed goniotomy or trabeculotomy and 6 eyes had undergone trabeculectomy more than 3 times. The overall success rate of repeated trabeculectomy was 63.9% and the success rate of the 14 eyes operated on with mitomycin C was not higher than that of the 9 eyes that did not receive mitomycin C (p=0.166). Two eyes were reported to have postoperative hypotony and there was one case of endophthalmitis after trabeculectomy; however, the use of mitomycin C did not increase the overall rate of surgical complication (p=1.00). CONCLUSIONS: Repeated trabeculectomy can be considered as a procedure to treat primary congenital glaucoma, particularly in severe cases of congenital glaucoma.

Three Cases of Descemet's Membrane Detachment after Cataract Surgery

Descemet's membrane detachment (DMD) is an uncommon condition with a wide range of etiologies. More than likely, the most common cause is a localized detachment occurring after cataract surgery. We report three cases of Descemet's membrane detachment that occurred after uncomplicated phacoemulsification cataract surgeries. The first patient was managed without surgical intervention, the second patient was treated using an intracameral air injection, and the last patient was treated with an intracameral perfluoropropane (C3F8) gas injection. All three patients recovered their vision following the reattachment of Descemet's membrane. The three patients were treated according to the extent of the detachment.

Increased Tear TNF-alpha and MMP-9 in Patients with Necrotizing Scleritis after Pterygium Excision

PURPOSE: We collected tear or scleral tissues of necrotizing scleritis after pterygium excision, and evaluated them for tumor necrosis factor (TNF)-alpha and matrix metalloproteinase (MMP)-9 to elucidate the molecular basis and seek for treatment of this disease. METHODS: Three patients with necrotizing scleritis after pterygium excision were evaluated for MMP-9 and TNF-alpha in tear and scleral tissue by Western blot analysis. RESULTS: Before treatment with corticosteroid, the patients' tear samples showed increased expression of TNF-alpha and MMP-9 compared to those of the contralateral eye. After treatment, the expression of TNF-alpha and MMP-9 was decreased compared to those of the pre-treated tear samples. The patients' sclera showed increased expression of MMP-9 compared to that of the donors' sclera and the patients' conjunctiva. CONCLUSIONS: Our results suggest that cytokine-related inflammation plays a role in the pathophysiology of necrotizing scleritis and strongly supports, under the guarantee of negative microbiological culture, the prompt use of corticosteroid and immunosuppressive agents to help suppress the progression of this disease.

A Case of Ocular Torticollis Associated with Inferior Rectus Muscle Transection

A 31-years-old female presented with left eyelid, canalicular, and conjunctival lacerations after struck by a glass bottle.She had left hypertropia and limitation of depression.Primary repairs of left eyelid, canalicular, and conjunctival laceration were performed that day.After two weeks, the explorative operation was done because of the inability of depression of left eye. We identified the transection of inferior rectus muscle, and repaired it.Three months after second operation, there were 12 prism diopters of left hyper-tropia, 12 prism diopters of left exotropia in the primary position, and 20 prism diopters of left hypertropia in left down gaze.Double Maddox rod testing revealed 6degrees of left incyclotropia, and she presented head tilt to the left. Four months after second operation, 5 mm recession of left superior rectus muscle was done.Postoperatively, she had nearly orthotropia in primary position, but 10 prism diopters in left downgaze.She had only 2 degrees of left incyclotropia, and showed the improvement of ocular torticollis.

The Common Causes of Visual Disturbance in the Old

No abstract available.

The Common Causes of Visual Disturbance in the Old

No abstract available.

Ocular Dominance Determined by Near Point of Convergence Test in Intermittent Exotropia

This study was designed to validate the usefulness of the near point of convergence(NPC)test in determination of dominant & non-domnant eyes in intermittent exotropia patients. We performed NPC test in 36 intermittent exotrpic patients, and then, determined the non-dominant eye which deviated outward beyond the NPC. The dominant eyes determined by the NPC were compared to those that were determined by amblyopia, sensory fusion and photophobia. Best corrected visual acuity was used to divide patients into two groups : 26 patients without amblyopia, and 10 with amblyopia. Among the amblyopia group, if the eyes with better visual acuity were taken as dominant eyes, then eight(80%)cases were identical with the NPC test and two(20%)cases were different. Ten patients had sensory anomaly, and among then, nine(90%)cases were identical with the NPC test and one(10%)case was different. Twenty six(64%)patients had photophobia in one eye and all(100%)cases were identical with the NPC test. In intermittent exotropia, determination of dominant eye by the NPC test showed high coincidence with other tests. Therefore, we suggest that the NPC test is an easy and accurate method in determining either the dominant or non-dominant eye for surgery.

Palpebral myiasis

Myiasis is most prevalent in Mexico, central and south America, tropical Africa, and the southwestern United States. Although dermal myiasis is rare in most of the United States, it is a disorder that may be seen in international travelers. In the United States, external myiasis is usually caused by the cattle botfly. We report here a case of ophthalmomyiasis involving the left upper eyelid of a child. We examined a six-year-old boy who presented to the Massachusetts Eye and Ear Infirmary (MEEI) in September 1998. He complained of persistent swelling of his left upper eyelid for the previous ten days. The edema and erythema were unresponsive to warm compresses and oral antibiotics. Ocular examination revealed a mild preseptal cellulitis of the left upper eyelid with a small draining fistula. On slit-lamp examination, we found one larva protruding intermittently from the fistula site. The larva was extracted with forceps, wrapped in a moist towel and sent in a jar to the parasitology laboratory. The specimen was identified as a Cuterebra larva by a parasitologist at the Harvard School of Public Health. One week later, the patient's eyelid edema and erythema had completely resolved.

An Efficacy of Head Tilt Test in the Patients with Unilateral Superior Oblique Palsy

Head tilt test is useful in diagnosing cyclovertical muscle palsy, especially superior oblique palsy, In this study, we observed efficacy and pattern of head tilt test in 12 patients of unilateral superior oblique palsy(7 congenital, 4 traumatic and 1 vascular) who had abnormal head tilt to nonparetic side. The results of head tilt test were compared to preoperative status in 8 patient, 3 month after surgery. All patients in this study showed positive response of head tilt test. Among them, 9 patients showed definite elevation of paretic eye. However, 2 patients mainly showed definite depression of nonparetic eyes that were amblyopic. The last patient did not show definite vertical deviation in either eye but complained of increasing diplopia. After surgery, abnormal head tilt and positive head tilt response disappeared in 7 patients. In conclusion, preoperative head tilt test is one of the valuable methods in diagnosisng unilateral superior oblique palsy especially in young patients and in those who developed spread of comitance. In addition, the positive head tilt test does no always mean the elevation of paretic eye.

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.

A Case of Adenoid Cystic CArcinoma of Unusually Located Lacrimal Gland

An adenoid cystic carcinoma of the lacrimal gland is the most common epithelial neoplasms in lacrimal gland. But it is rare in clinical practice and is poor prognosis below 50% at 2 year survival rate with various clinical management. We experienced a case of a 62-year-old woman who had complained just proptosis and no other tumor symtoms. Being different from the other adenoid cystic carcinoma of the lacrimal gland, MRI revealed mass of the right superiotemporal lacrimal gland which was well demarcated and displaced in nasal area to the optic nerve and no metastasis to adjacent nerves and bones. We performed the lateral orbitotomy followed by macroscopical complete resection of tumors. The histopathologic findings revealed the adenoid cystic carcinoma of the lacrimal gland and were showed variable. So we would report our case with a brief review of the literature.

A Case of Metastatic Uterine Cervical Carcinma of the Orbit

In adults, it is known that tetastatic tumor to the eye and its adnexa is rare compared with other sites. Orbital tumors can be classified as primary, secondary, and metastatic. Secondary orbital tumors are those that extend to the orbit from a contiguous structure. Metastatic tumors are those that spread to the orbit from more distant site in the body. and their prognosis for life is poor because of widespread systemic malignancy. We experienced a case of metastatic uterine cervical carcinoma of the orbit in a 33-year-old female patient who came to us with a history of sudden proptosis and decreased vision. Eighteen months earlier, the patient had been diagnosed with squamous cell carcinoma of the uterine cervix, and she had undergone chemotherapy, irradiation and surgical intervention. Lung and parametrium metastases were also found six months previously. We report a case of metastatic uterine cervical cancer of the orbit with a review of the literature.

Oculocardiac Reflex During Strabismus Surgery

We perfomed this study to evaluate the incidence of the oculocardiac reflex(OCR) and its difference relative to each extraocular muscles. In addition, preventive methods for oculocardiac reflex were also evaluated. From Febrary 1997 to January 1998, we examined the occurrence of the OCR of 65 patients who underwent strabismus surgery in 123 extraocular muscles under the general anesthesia. Those who showed severe OCR were prepared with retrobulbar injection of 1% lidocaine 2cc or 1% intravenous atropine and observed wheather OCR was prevented. The overall incidence of the OCR was 66.2% and there was no significant difference between the incidence in both eyes(p>0.999). The incidence in each of the extraocular muscles did not show statistically significance when the patients were prepared with preoperative intramuscular atropine(p=0.018). The incidence after intraoperative retrobulbar injection or intravenous atropine was decreased to 27.3% but was not statistically significant(p=0.34).

Expression of Neurofilament Protein in the Nerve of Human Cornea

This study was performed to identify the expression of neurofilament in sensory nerve of human cornea. The three normal corneal tissues were dissected. Monoclonal antibody to neurofilament protein were used to visualize the corneal nerve. The one normal cornea was examined to observe the corneal nerve with electron rnicroscope. Transmission electron rnicroscope showed that the corneal nerve contained the neurofilament within the axon. The indirect iinmunofluorescent techniques revealed the expression of neurofilament in corneal stroma. The results of this study show that immunofluorescent technique may useful method in identification of sensory nerve of human cornea, and make it easy for us to visualize corneal innervation pattern in flat section by using of antibody to neurofilament protein.

A Case of Guillain-Barre Syndrome Presented as Bilateral Sixth Nerve Palsy

Guillain-Barre syndrome, acute inflammatory polyradiculoneuropathy, is sometimes accompanied by a typical ophthalmoplegia, usually with bilateral sixth nerve palsy. It also has a similar clinical appearance with Miller-Fisher syndrome, but it is differentiated by limb weakness without ataxia. We observed a 47 year old man with acute onset diplopia and bilateral sixth nerve palsy one week after URI symptoms, diagnosed as Guillain-Barre syndrome with ophthalmoplegia.

Clinical Evaluation of Endoscopic Transnasal Dacryocyocystorhinostomy

The purpose of our study was to evaluate the effectiveness of endoscopic transnasal dacryocystorhinostomy(DCR) in patients who had lacrimal obstruction. Between June 1995 and December 1996, 19 patients(20 eyes) who had undergone endoscopic transnasal DCR were evaluated for follow up of at least 3 months. All patients were preoperatively examined by an otolaryngologist. Eleven cases were operated on intranasal diseases(sinusitis, septal deviation, enlarged middle turbinate) at the same time. Lacrimal obstruction was completely relieved in 16 patients (80%) for a follow-up of 3 months. Granulation was formed in 4 patients after 3months. There were two postoperative complications including bleeding and periorbital swelling on the first day after operation. In conclusion, endoscopic tansnasal DCR appears to be a safe, effective procedure which should be considered as an alternative to conventional external DCR for the surgical treatment of nasolacrimal duct obstruction.

Result of Excimer Laser Photorefractive Keratectomy Correction of Myopia: One and Two-Years Follow-up

To examine prospectively the efficacy and reliability of excimer laser photorefractive keratectomy for myopia. we treated 147 eyes of 86 patients with a VisX Twenty/Twenty excimer laser and followed them up for 1 year and follow up 48 eyes of 26 patients for 2 years. The patients were divided into two groups with preoperative myopia: group 1 with diopters between -1.50 and -6.00, group 2 with diopters between -6.01 and -10.00. At 1 year, the group 1 with a mean preoperative refractive error of -4.61D changed to -0.40D, the group 2 changed from -7.50D to -0.92D. At 2 years, the group 1 with a mean preoperative refractive error of -4.28D changed to -0.41D, the group 2 changed from -7.75D to -1.04D. At 1 yera, in group 1, 90.91% (70 of 77) of eyes and in group 2, 64.29%(45 of 70) of eyes were corrected within 1D of intended refraction,respectively. At 1 years, in group 1, 94.81% (73 of 77) of eyes and in group 2, 84.29%(59 of 70) of eyes achieved an uncorrected visual acuity of 0.5 or better. And at 2 years, in group 1, 81.82% (18 of 22)of eyes, and in group 2, 50.00% (13 of 26) of eyes were corrected within 1D of intended refraction, respectively. At 2 years, in group 1, 95.50% (21% of 22) of eyes and in group 2, 84.62%(22 of 26) of eyes achieved an uncorrected visual acuity of 0.5 or better.

Comparative study of eosinophil counts and eosinophil catonic protein(ECP), soluble vascular cell adhesion molecule-l(VCAM-1) in tears and sera in children with allergic conjunctivitis / 알레르기

The eye is a common target organ of the allergy, and allergic conjunctivitis is the most common of eye diseases. Clinical manifestations of allergic conjunctivitis are acute bilateral red, itchy, and watery eyes. The presence of conjuncitival eosinophilia may be consided to be a diagnostic indicator of allergic conjunctivitis. ECP is a quantifiable toxic product secreted by activated cosinc phils. VCAM-1 promotes adhesion of leukocytes to endothelium in vitro and may promote imflammation in vivo. The objective of this study is to measure eosinophil count, ECP and sVCAM-1 levels of tears and sera in patients with acute allergic conjunctivitis and normal subjects and to assess the correlation of these mediators with the severity of the disease and the clinical usefulness. Seventeen subjects were selected on the basis of clinical manifestations, history, skin prick test, total IgE. A microcapillary tube was used to collect the tears from the inner canthus, conjunctival epithelia were obtained for eosinophil count by scraping the upper tarsal conjunctiva. The level of ECP was measured by CAP system (Kabi-Pharmacia, Sweden), sVCAM-1 was measured by ELISA (R&D, USA). Serum IgE and eosinophil count were in creased in 10 patients, allergic skin prick test were positive in 11 subjects (D.p: 9, D.f: 8), eosinophilia in conjunctival epithelium were present in 11 subjects (4 patients: > 3/HPF, 7 patients: 1-3/HPF). ECP in tears were increased in patients significantly (12.0+8.0 vs 3.9+3.8 ng/ml, p=0.01), but not in serum (52.5+43.1 vs 28.3+25.9 ng/ml). There is no significant correlation between eosinophil count and ECP in serum and tears (p>0.05, r-=0.19). Serum sVCA-M-1 level is significant different between patients and controls (1916.5+756.0 vs 1147.2+146.1 micro gram/ml, p=0.01), sVCAM-1 is significantly correlated to eosinophil count (p=0.01, r=0.56) and ECP (p<0.05, r=0.65). In conclusion, eosinophil and ECP in tears may be very important role in allergic conjunctivitis and are useful indicators of the disease. The elevation of sVCAM-1 in serum may be interpreted simply as marker of the presence of non-specific inflammation.

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.

Comparative study of Eosinophil and Eosinophil Cationic Protein (ECP) of Tears and Sera in Children with Allergic Conjunctivitis

The objective of this study is to measure eosinophil count and Eosinophil Cationic Protein (ECP) levels of tears and sera in patients with acute allergic conjunctivitis and normal subjects and to assess the correlation of this mediator with allergic conjuctivitis and the clinical usefulness. Seventeen subjects were selected on the basis of clinical manifestation, history, skin prick test, total IgE. Serum IgE and eosinophil count were increased in 10patients, and eosinophilia in conjunctival epithelium were present in 11subjects. ECP in tears were increased in patients significantly (12.0+/-8.0 vs 3.9+/-3.8ng/ml,p=0.01), but not in serum (52.5+/-43.1 vs 28.3+/-25.9ng/ml). There was significant relationship beween serum and tear eosinophil count(p=0.004,r=0.66). But there was no significant correlation between eosinophil count and ECP in serum (p>0.05m r=0.19), and no significant correlation between eosinophil count of conjectival epithelium and tears ECP (p=0.043, r=0.05). In conclusion, ECP in tears may be very important role in allergic conjunctivitis and is more reliable indicatior of diagnosis clinically rather than eosinophil count in tear and conjunctival epithelium.