Comparison of short-term visual acuity and visual disturbance phenomena and spectacle independence after implantation of three different intraocular lenses / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the short-term postoperative visual acuity, visual disturbance phenomena, and spectacle independence rate in patients who underwent monocular implantation with trifocal, multifocal, or extended range of vision intraocular lens(IOL).METHODS: A retrospective analysis was conducted on 67 cataract patients(67 eyes)who underwent phacoemulsification cataract extraction combined with IOL implantation from March 2019 to December 2022. A total of 35 cases(35 eyes)received Symfony extended range of vision IOL implantation, 21 cases(21 eyes)received AcrySof IQ ReSTOR +3D multifocal IOL, and 11 cases(11 eyes)received AcrySof IQ PanOptix trifocal IOL. The preoperative uncorrected distance visual acuity(UDVA), uncorrected intermediate visual acuity(UIVA), and uncorrected near visual acuity(UNVA)and 3 mo postoperatively were documented. Moreover, defocus curves, visual disturbance phenomena, and spectacle independence rates were recorded at 3 mo postoperatively.RESULTS: At 3 mo postoperatively, no statistically significant differences were observed in UDVA among the three groups(P>0.05). A comparison of UIVA showed superior results in the Symfony and PanOptix groups compared to the ReSTOR group(all P<0.01). The UNVA of both the ReSTOR and PanOptix groups outperformed the Symfony group(all P<0.01). The defocus curves indicated that in the intermediate vision range(-1.00 to -1.50 D), the Symfony group exhibited better performance than the ReSTOR group(P<0.05); while in the near vision range(-2.50 to -3.50 D), the ReSTOR group was superior to the Symfony group(P<0.05). The PanOptix group demonstrated superior visual acuity in the near vision range(-2.00 to -3.50 D)compared to the Symfony group(P<0.05)and was also superior in the intermediate vision range(-1.00 to -2.00 D)compared to the ReSTOR group(P<0.05). No significant differences were observed in the incidence of glare or halo and binocular interference phenomena among the three groups(P>0.05). The PanOptix and ReSTOR groups exhibited a higher spectacle independence rate compared to the Symfony group(P<0.0167).CONCLUSION: Compared to Symfony extended range of vision IOL and ReSTOR multifocal IOL, PanOptix trifocal IOL offers a balanced approach to distance, intermediate, and near visual acuity, without a high incidence of glare and halo, and with a higher spectacle independence rate. Caution is still advised when considering monocular implantation with presbyopia-correcting IOLs.

Research progress of visual snow syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

@#A systematic review of visual snow syndrome(VSS)was introduced in this article. Scientists don't know what caused visual snow syndrome for sure, but studies have shown that patients with VSS experience continuous television-static-like tiny flickering dots in the entire visual field and additional visual symptoms such as palinopsia, entoptic phenomena or photophobia or nyctalopia. Literature in recent years on the clinical and pathophysiological researches of VSS was reported, and in the latest literature, the VSS was more inclined to be seen as a visual processing disorder. It should be distinguished from the migraine and other diseases. In terms of treatment, current studies focused on experimental studies. Some case reports showed that anti-Seizure medications, antidepressants, or acetazolamide and colored filter-sheet may be effective in eliminating symptoms.

Unilateral mydriasis: a complication of spine surgery in prone position / Midríase unilateral: uma complicação da cirurgia de coluna em decúbito ventral

Abstract Prone position though is commonly used for better access to surgical site, but may be associated with a variety of complications. Perioperative Visual Disturbances or loss is rare but a devastating complication that is primarily associated with spine surgeries in prone position. In this case we report a 42 year old ASA-II patient who developed anisocoria with left pupillary dilatation following lumbar microdiscectomy in prone position. Following further evaluation of the patient, segmental pupillary palsy of the left pupillary muscles was found to be the possible cause of anisocoria. Anisocoria partially improved but persisted till follow up.

Resumo O posicionamento em decúbito ventral, embora comumente usado para melhorar o acesso ao local cirúrgico, pode estar associado a uma variedade de complicações. Distúrbios ou perda visual no Perioperatório é uma complicação rara, mas devastadora, que está principalmente associada à cirurgia de coluna vertebral em decúbito ventral. Relatamos aqui o caso de um paciente de 42 anos de idade, ASA - II, que desenvolveu anisocoria com dilatação pupilar esquerda após microdiscetomia lombar em decúbito ventral. Após uma avaliação adicional do paciente, observamos que a paralisia segmentar dos músculos pupilares esquerdos seria a possível causa de anisocoria. A anisocoria melhorou parcialmente, mas persistiu até o acompanhamento.

Screening of Workers with Presumed Occupational Methanol Poisoning: The Applicablility of a National Active Occupational Disease Surveillance System

BACKGROUND: Methyl alcohol poisoning in mobile phone–manufacturing factories during 2015–2016 was caused by methyl alcohol use for cleaning in computerized numerical control (CNC) processes. To determine whether there were health complications in other workers involved in similar processes, the Occupational Safety and Health Research Institute conducted a survey. METHODS: We established a national active surveillance system by collaborating with the Ministry of Employment and Labor and National Health Insurance Service. Employment and national health insurance data were used. Overall, 12,048 employees of major domestic mobile phone companies and CNC process dispatch workers were surveyed from 2016 to 2017. We investigated methyl alcohol poisoning by using the national health insurance data. Questionnaires were used to investigate diseases due to methyl alcohol poisoning. RESULTS: Overall, 24.9% of dispatched workers were employed in at least five companies, and 23.9% of dispatched workers had missing employment insurance history data. The prevalence of blindness including visual impairment, optic neuritis, visual disturbances, and alcohol toxicity in the study participants was higher than that reported in the national health insurance database (0.02%, 0.07%, 0.23%, and 0.03% versus 0.01%, 0.07%, 0.13%, and 0.01%, respectively, in 2015). Moreover, 430 suspicious workers were identified; 415 of these provided an address and phone number, of whom 48 responded (response rate, 11.6%). Among the 48 workers, 10 had diseases at the time of the survey, of whom 3 workers were believed to have diseases related to methyl alcohol exposure. CONCLUSION: This study revealed that active surveillance data can be used to assess health problems related to methyl alcohol poisoning in CNC processes and dispatch workers.

Recent advance in idiopathic intracranial hypertension / 中华神经医学杂志

Idiopathic intracranial hypertension (IIH) is a clinical syndrome manifested as headache,transient visual disturbance,and pulsatile tinnitus,characterized by increased intracranial pressure,and involved Departments of Neurology,Neurosurgery,Ophthalmology,Otorhinolaryngology and other disciplines.Due to increase of obese people,incidence of IIH is still increasing.With the development and application of imaging,ocular coherence tomography and transanal ultrasound detection technology,the application of stenting for purpose of protecting vision has increased,people's understanding of IIH has been improved and diagnostic criteria have been revised,and acetazolamide has been clarified as the first-line treatment,but its exact mechanism remains to be confirmed by further studies.This article is now summarized as follows for IIH,in order to allow clinicians to raise awareness of the disease.

Dengue Fever Presenting as Bilateral Dengue Maculopathy

Dengue fever is a common pyrexial-viral infection in the Asian region and the incidence is increasing yearly. There are various ocular manifestations of dengue fever such as maculopathy, retinal hemorrhages, retinal lesions and vasculitis. Reduction in visual acuity and other visual disturbances such as metamorphopsia is the most common presentation of dengue-associated maculopathy. We report an interesting case of a young lady with bilateral maculopathy secondary to dengue fever who was managed conservatively with dramatic visual improvements. This case highlights the possibility of bilateral and simultaneous ocular involvements in patients infected with dengue fever. Both ophthalmologists and physicians need to be aware of ocular complications following dengue fever and advice patients regarding the symptoms.

Vogt-Koyanagi-Harada disease in an 8-year-old boy

Vogt-Koyanagi-Harada (VKH) disease is an autoimmune disease involving pigmented tissue in eyes, auditory system, skin, and central nervous system. The pathogenesis is a result of T cell lymphocyte reaction against melanocyte component, tyrosinase and tyrosinase-related protein. This disease uniquely affected pigmented race in Asia and native America, mostly women aged 20-50. We reported an 8-years-old boy complained for visual disturbance since 6 weeks prior admission. Two years earlier, the parents noted the patient eyes were looked red when photographed (suggesting a dilated pupil) preceded by whitened on the right forehead and nose and whitened hair, eyebrow and eyelashes. The examination showed a vitiligo and skin atrophy on right frontal and right nasal, poliosis on the eyebrows, eyelids and hair. The diameter of right pupil was 8 mm, with a paresis on 3rd, 4th, 6th, and 9th nerves. Fundus examination revealed sunset glow appearance. The visual acuity on the right eye: 2/60, left eye: 1-0. There's positive serology for antitoxoplasma IgG, anti Rubella IgG, anti CMV IgG. The patient was diagnosed with a VKH disease and then prescribed with methylprednisolone 1 mg/kg/day. The patient also had further follow up with dermatovenerologist and ophthalmologist. The eye examination revealed an improvement on right eye panuveitis, with a remaining keratic precipitate in the endothelium, and minimal flare and cell on the anterior chamber. ENT consultation revealed no ear inflammation or hearing disturbance.

Visual Impairment and Quality of Life Among Elderlies in Nursing Home / Jurnal Sains Kesihatan Malaysia

Visual Functions are affected by the aging process and without appropriate intervention eventually will results in diminishing visual acuity. As the situation proceeds difficulty to perform daily life activities ensureand will impact on the quality of life especially in the elderly. The objective of this study was to determine the effect of visual impairment towards daily activities and quality of life among elderly. Measurements that were conducted included visual acuity at distance using the LogMAR Chart to determine the level of visual impairment, quality of life test using the Low Vision Quality of Life (LVQOL) questionnaire and ability to cope with the activities of daily life was measured using the Barthel Index (BI). It was found that visual function progressively worsens with age, as did the BI which declined as visual function worsened. The LVQOL score reduced significantly with worsening visual ability. Thirty five percent of the elderly in this study required some form of optometric and low vision intervention. In conclusion, the deterioration in the functions among elderly can reduce the ability to cope with the daily life activities. Other than that, uncorrected visual acuity will cause reduction in the quality of life among the elderlies

Neurocysticercosis Involving the Pituitary Stalk : Case Report and Literature Review

Neurocysticercosis (NCC) is the most common parasitic infestation of the central nervous system. Most cases of NCC are to related and/or associated with inflammation within the cerebral parenchyma. A 71-year-old woman presented with a 4-year history of visual disturbance. This symptom had become aggravated 4 weeks earlier. Her visual acuity gradually decreased and superior hemianopsia was noted. Magnetic resonance imaging (MRI) revealed an enhanced and thickened pituitary stalk accompanying a suspicious mass. The provisional diagnoses were lymphoma, glioma, or other inflammatory conditions. Laboratory studies, including blood and hormonal studies, showed normal findings. Surgical resection was performed. In the pathological examination, degenerated parasitic wall structure was seen and its contents were composed of completely degenerated focal globular structures suggesting the scolex of cysticercus. We report an unusual case of NCC involving the pituitary stalk which was presented with a juxtasellar tumor. The possible underlying mechanisms are discussed with a review of pertinent literature.

A Case of Syphilitic Uveitis in an Immunocompetent Patient / 감염과화학요법

Syphilis is re-emerging worldwide due to the HIV epidemic. Prior to the introduction of penicillin, syphilis was the second most common primary cause of all cases of uveitis. Today, ocular syphilis is a rare disease, especially in an immunocompetent patient. Variable manifestation without pathognomonic signs of ocular syphilis often lead to delayed diagnosis, resulted in irreversibile loss of vision. In Korea, syphilitic uveitis has not been reported in an immunocompetent patient since 1984. We experienced a case of syphilitic uveitis in an immunocompetent man with visual deterioration. As the incidence of syphilis is increasing in these days, a high degree of clinical suspicion should be considered in patients with unexplained ocular inflammation and visual disturbances.

A Case of Syphilitic Uveitis in an Immunocompetent Patient / 감염과화학요법

Syphilis is re-emerging worldwide due to the HIV epidemic. Prior to the introduction of penicillin, syphilis was the second most common primary cause of all cases of uveitis. Today, ocular syphilis is a rare disease, especially in an immunocompetent patient. Variable manifestation without pathognomonic signs of ocular syphilis often lead to delayed diagnosis, resulted in irreversibile loss of vision. In Korea, syphilitic uveitis has not been reported in an immunocompetent patient since 1984. We experienced a case of syphilitic uveitis in an immunocompetent man with visual deterioration. As the incidence of syphilis is increasing in these days, a high degree of clinical suspicion should be considered in patients with unexplained ocular inflammation and visual disturbances.

Visual Disturbance following Autologous Fat Injection into Periorbital Area

PURPOSE: Autologous fat injection into the facial area is a frequently used technique in aesthetic plastic surgery for augmentation of the soft tissue. Fat injection is a very safe procedure because of the advantage of being autologous tissue. Minimal foreign body reaction or infections are noted after fat injection. However, there may be some complications including those as severe as blindness. There have been some case reports on visual disturbances after autologous fat injection reported in the literature. METHODS: A 21-year-old female patient underwent autologous fat injection into left eyebrow area to correct depression of soft tissue. Immediately after injection of autologous fat, she complained sudden visual loss on the left eye. She had come to our emergency room and ophthalmologic evaluation showed that the patient could only recognize hand motion. There was no abnormality of the optic nerve on magnetic resonance imaging. Suspecting an ischemic optic neuritis from fat embolism of the central retinal artery, the patient was treated conservatively with occular massage, antiglaucomatic agent, anti-inflammatory drugs and antibiotics. Visual field examination showed visual defect of half the lower hemisphere. RESULTS: While maintaining antiglaucomatic agents and non steroidal anti inflammatory drugs, fundoscopic examination showed no abnormalities on the second day of admission. Visual field examination showed an improvement on the fourth day along with decreased eyeball pain. Significant improvement of vision was noted and the patient was discharged on the fifth day of admission. The patient was followed-up 2 days afterwards with improved vision and visual field defect. CONCLUSION: We describe an unusual case of sudden unilateral visual disturbance following autologous fat injection into periorbital area.

A Case of Weaver Syndrome with Alternating Exotropia

PURPOSE: We report a first case of Weaver syndrome in Korea, accompanied by alternating exotropia and visual disturbance. METHODS: An 11-month-old girl showed the characteristic symptoms of Weaver syndrome along with alternating exotropia and visual disturbance. RESULTS: Ophthalmologic findings included alternating exotropia, hypertelorism, down-slanting palpebral fissure, and telecanthus. The angle of exotropia according to the Krimsky's test was 60 prism diopters. No limitation of extraocular movement was present. Visual acuity of both eyes showed poor following fixation. According to brain MRI, immature myelination of the anterior limb of the internal capsule, contracture and sclerotic changes of the optic canal and superior oblique fissure were present. Both optical nerves ran abnormally crooked. CONCLUSIONS: The author experienced a child with Weaver syndrome who showed alternating exotropia, visual disturbance, and characteristic findings according to brain MRI. Thus, we report one case of Weaver syndrome never been reported in Korea with the literature study.

Transient visual disturbance / 医学研究生学报

Transient visual disturbance(TVD) is caused by artery stenosis,or artery embolism and migraine,which lead to reduction of eye blood flow,retinal ischemia and hypoxia.Major clinical manifestations include amaurosis fugax and visual transient ischemic attacks(TIA).The present research situation and progression of TVD were reviewed.

Moyamoya Disease Initially Presenting Visual Field Defect

Progressive narrowing of distal carotid arteries and the development of compensatory fine networks are the characteristic findings of moyamoya disease. Cerebral infarction in moyamoya disease is due to a decreased blood flow and shows an uneven distribution in the distal bed of the anterior and middle cerebral arteries. The progression of disease in the posterior circulation follows that in the anterior circulation. Posterior circulation symptoms due to cerebral infarction usually occur in the advanced stage of the disease and follow the anterior circulation symptoms. We encountered an unusual case of moyamoya disease which initially presented with a transient visual field defect. One month later our patient developed blindness and her cerebral angiography showed advanced moyamoya disease.

A Case of Primary Empty Sella Syndrome Associated with Visual Symptom

Empty sella syndrome shows partial or total loss of pituitary tissue and enlargement of the sella turcica due to incomplete diaphragm sellae and herniation of subarachnoid space through the defect. This syndrome usually occurs in obese, hypertensive, and cephalgic women, but it is often asymptomatic. We report a case of primary empty sella syndrome diagnosed by magnetic resonance imaging scan with literature review in 57-year-old female patient who had had unilateral cataract operation and presented with bilateral visual disturbance and bitemporal hemianopsia at postoperative 2 months.

Nefazodone and Associated Perceptual Disturbance : A Report of Four Cases

Nefazodone, a newer antidepressant is a phenylpiperazine derivative that inhibits the reuptake of both norepinephrine and serotonin, and antagonizes 5-HT2A and alpha1 adrenergic receptors. Compared with SSRIs nefazodone caused the fewer activating symptoms, adverse gastrointestinal effects(nausea, diarrhea, anorexia) and adverse effects of sexual function, but is associated with the more dizziness, dry mouth, constipation, visual disturbances and confusion. We report on 4 cases of visual disturbances and hallucinations in patients taking nefazodone. 1) Nefazodone, as a 5-HT2A antagonist, might induce visual disturbances. 2) mCPP, metabolite of nefazodone might contribute to the hallucination through action on 5-HT receptor. 3) Dopaminergic enhancing activity of nefazodone might cause hallucination. The case report raises the possibility that dose-related perceptual disturbances may exist with nefazodone. The fact emphasizes the need to pay close attention to all possible drug interactions, particularly in patients treated with multiple psychoactive agents, older patients, and patients with decreased hepatic function.

Assessment by questionnaire of disease status of the pupils in two primary schools in Seoul

We studied the disease status by question-naire in seoul of the pupils in two primary schools on May, 1991 and carried out statistical analysis of their results. The following results were observed: 1) Total number of answered pupil was 2330; 1103 were male and 1227 were female and the ratio of male to female was 1:1.1. Average age was 9.27 years. 2) Number of the pupil with any present described was 499(21.4%) Majority was as follows: (1) Respiratory system diseases; 358(71.1%) (2) Skin & Subcutaneous tissue diseases; 36(7.2%) (3) Circulatory system diseases; 14 (2.8%) (4) Infectious diseases; 11 (2.2%) (5) Trauma; 7 (1.4%) 3) Number of the pupil with any disease on treatment was 225 (9.7%). Majority was as follows: (1) Respiratory system diseases; 108 among 358 (2) Skin & Subcutaneous diseases; 22 among 36 (3) Infectious diseases; 11 among 11 (4) Trauma; 3 among 7 (5) Mental disorders; 1 among 6 4) Number of the pupils with the past history of diseases described was 561 (24.1%). Majority was as follows: (1) Respiratory system diseases; 217 (38.7%) (2) Infectious diseases; 105 (18.7%) (3)Trauma; 74 (13.2%) (4) Nervous system & Sense organ diseases; 39 (7.0%) (5) Digestive system diseases; 27 (4.8%) 5) Number of the pupils with the past hospitalization history was 190 (8.2%). Majority was as follows: (1) Respiratory system diseases; 48 (25.3%) (2) Trauma; 41 (21.6%) (3) Infectious diseases; 18 (9.5%) (4) Genitourinary system diseases; 9 (4.7%) (5) Digestive system diseases; 6 (3.2%) 6) Number of the pupils with the past history fo sugery was 362 (15.5%). The types of surgery of the causative diseases requiring surgery were as follows: (1) Circumcision; 98 (4.2%) (2) Trauma; 73 (3.1%) (3) Tonsillectomy & Adenectomy; 46 (2.0%) (4) Inguinal herniectomy; 25 (1.1%) (5) Appendictomy; 10 (0.4%) (6) Intussusception; 10 (0.4%) 7) Number of the pupils with hearing disturbance was 498 (21.4%), with present illness of otitis media 19 (0.82%) and with the past history of otitis media 15 (0.64). 8) Number of the pupils with visual disturbance was 498 (21.4%), with myopia 233 (10%), with hyperopia 49 (2.1%), with strabismus 16 (0.7%), color blindness 7 (0.3%). 9) Number of the pupils hoping to consult with the physicians were 446 (19.1%). The contents of their consultation were as follows: (1) Dental problems; 81 (18.0%) (2) Extremity pain; 56 (13.0%)(3) Abdominal pain; 52 (12.0%) (4) Skin disease; 34 (7.6%) (5) Headache; 30 (6.7%) 10) Number of the pupil sttended to school inspite of disease was 846 (36.3%). The caustive diseases were as follows: (1) Upper respiratory infection; 217 (25,7%) (2) Abdominal pain; 27 (3.2%) (3) Fever; 24 (2.8%) (4) Trauma; 8 (0.9%) (5) Infection (Measles, Mumps, Chicken pox et.); 6 (0.7%) .

A Case of Compressive Optic Neuropathy Caused by Sphenoid Sinus Mucocele

One of causes of compressive optic neuropathy is the sphenoid mucoceles which occur when the dranage of sinus is blocked. Mucocele of sphenoid sinus is rare, compressive to optic nerve and often misdiagnosed as pituitary tumor. We experienced a case of sphenoid sinus mucocele causing progressive visual disturbance, visual field defect, exophthalmos and headache. Plain skull and brain CT scan demonstrated sphenoid sinus mucocele. The visual acuity and visual field dramatically improved after surgery. Therefore early accurate detection and early surgical treatment are emphasized.