Uveitis in a child: masquerade syndrome revisit.

We present a case of relapsing acute lymphoblastic leukemia (ALL) in the anterior chamber, uveitis masquerade syndrome, which was confirmed by anterior chamber paracentesis and aqueous fluid cytology. Three months previously, the patient developed anterior uveitis without hematologic relapse. The uveitis responded well to topical steroid. After anterior chamber paracentesis, bone marrow relapse was detected. High doses of chemotherapy were prescribed. Ocular radiation was planned but the patient developed septicemia and expired. In our opinion, paracentesis should be performed without delay when uveitis develops in ALL, regardless of systemic relapse. Ocular manifestation may be the only sign of leukemic relapse or may present several months prior to systemic relapse.

Botulinum toxin treatment of the sixth nerve palsy: an experience of 5-year duration in Thailand.

Forty-five patients (48 eyes) with sixth nerve palsy were treated with botulinum toxin injection to antagonist medial rectus muscle at Siriraj Hospital from October 1995 to September 2000. The common causes of palsy were ischemia, trauma and inflammation. Thirty-eight patients (group I) had an interval to treatment of less than 24 weeks (average, 8.7 weeks) and seven patients (group II), longer than 24 weeks. The mean pre-injection esodeviation and extent of abduction in group I were 28.1 prism diopters (PD) and 28.4 per cent, and in group II were 38 PD and 8.1 per cent respectively. After a mean follow-up of 12.2 months, twenty-seven (71.1%) patients in group I recovered completely after the first injection and three (7.9%), after the second injection with a mean interval to recovery of 8.1 weeks. One (14.3%) of 7 patients of group II obtained complete recovery without fusion. Twenty-six (83.9%) of 31 patients with complete resolution achieved binocular function. We conclude that botulinum toxin treatment is a safe and effective alternative to traditional surgery of acute onset sixth nerve palsy.

Retinal degeneration due to potassium iodate overdosage.

The potassium iodate toxicity in three patients who accidentally took an overdose of potassium iodate solution was reported. After ingesting the iodate solution in the oral dose of 187, 247 and 470.5 milligrams per kilogram body weight respectively. All patients had nausea vomiting and diarrhea. The visual loss developed within 2 to 20 hours later. All of the patients had visual acuities of hand motion in both eyes. The eye examination revealed retinal edema, hypopingment at macula with subsequent pigmentation at posterior pole and midperiphery of the fundus. The fluorescein angiogram and electroretinogram showed degenerative change of retinal pigment epithelium and photoreceptor cells. The visual acuity of the first case improved to 6/24 both eyes after 3 months.

Result of ptosis surgery.

The authors retrospectively studied patients undergoing ptosis surgery at the Department of Ophthalmology, Siriraj Hospital, from January 1986 to December 1990. A total of 123 follow-up cases were analyzed, 60 males there were 29 bilateral (23.6%), 16 reoperation (13%) and 95 congenital (77.2%) cases. The type of operations performed were 61 frontalis sling (49.6%), 56 levator resection (45.5%), and six other operation (4.9%). The mean times of follow-up and change in lid height were 14.8+27.3 and 11.6+23.7 weeks, respectively. Post-operative results at the last available visit were 95 successful cases (77.2%). Fifty-five cases of post-operative complications were found (44.7%), undercorrections being the most common (49.1%).

Causes of diplopia.

A prospective study of 96 diplopia patients was analyzed concerning the common types and causes in order to develop early and proper management. Two-thirds (62) of the patients were male (64.6%). The average age was 34.5 +/- 15.7 years (+/- SD). The result revealed that the common types of diplopia were horizontal, vertical and torsional diplopia, respectively. The common causes of diplopia were head trauma (38.5%), systemic diseases from diabetes mellitus, hypertension (20.8%), undetermined group (15.6%), eye diseases (9.4%), and etc. Sixth cranial nerve paralysis was frequently found among the third, fourth and sixth cranial nerves. There were 13 cases of spontaneous fusion in the primary position. Only 7 of 12 surgical cases eventually achieved satisfactory alignment and fusion.