Neovascular Glaucoma with Ocular Ischemia in Superior Vena Cava Syndrome

PURPOSE: To report a case of neovascular glaucoma (NVG) with ocular ischemia in superior vena cava syndrome (SVCS). CASE SUMMARY: A 57-year old male who had been treated for small cell lung cancer (SCLC) visited our hospital because of SVCS-like symptoms and decreased visual acuity in the right eye. On the initial examination, best corrected visual acuity was 0.5, intraocular pressure (IOP) was 38 mm Hg and relative afferent papillary defect was positive in the right eye. Slit lamp examination showed mild dilatation and tortuosity of the episcleral vessels and ruobeosis iridis. Gonioscopic examination showed neovascularization of the opened angle. Fluorescein angiography showed delayed choroidal filling and nevascularization of the disc. The patient was diagnosed with NVG with ocular ischemia in SVCS and was treated with chemotherapy and steroid therapy. In addition, intravitreal bevacizumab and IOP lowering eyedrops were administered to the right eye. During follow-up, neovascularizations disappeared and IOP was well controlled. CONCLUSIONS: NVG with ocular ischemia in SVCS should be considered as a possible cause of high IOP in SCLC patients.

Traumatic Eyeball Protrusion with Optic Chiasmal Injury

PURPOSE: To report a case of eyeball protrusion with optic chiasmal injury due to eyeball trauma. CASE SUMMARY: A 59-year-old male presented to the emergency room for right eyeball pain, eyeball protrusion and decreased visual acuity after collision with a metal pipe. On initial examination, the right eyeball was protruded, the patient could not perceive light, his pupil was dilated and did not respond to the light. The patient had a laceration of the lower canaliculi and the medial, superior and inferior rectus muscles were separated from the eyeball. Abnormal left pupil response was observed, and visual acuity of the left eye was 0.7. He underwent primary repair of the right medial, inferior and superior rectus muscles and reconstruction of the lower canaliculi. Because the visual field of the left eye at post-operative day 1 demonstrated temporal hemianopsia, an optic chiasmal injury was revealed on brain magnetic resonance imaging (MRI). The patient underwent left optic chiasmal decompression because the visual field was aggravated despite the immediate high dose of corticosteroid therapy. At post-operative 2 months, the patient's left visual acuity was 0.3 and the visual field was stable. CONCLUSIONS: Optic chiasmal injury should be considered and promptly diagnosed through visual field test and MRI when ipsilateral optic nerve injury with abnormal contralateral pupil response is caused by eyeball protrusion. Optic chiasmal decompression should be considered when traumatic optic nerve and chiasmal injuries do not respond to high-dose corticosteroid therapy.

Corneal Endothelial Changes Induced by Corneal Bee Sting Injury

PURPOSE: Corneal bee sting is a relatively rare injury. The authors report the significant endothelial changes despite complete resolution of corneal injury after a corneal bee sting. CASE SUMMARY: Two males, ages 55 and 30, presented to our clinic for unilateral decreased visual acuity and eyeball pain after bee sting injuries. At the first visit, localized corneal stromal edema and epithelial defect were detected. One week after medical treatments, both patients achieved restoration of vision and resolution of corneal injury. In one patient, specular microscopy of the traumatized eye at one and five months showed a significant decrease in endothelial densities as compared with the contralateral eye. CONCLUSIONS: Corneal bee sting may cause significant endothelial changes despite complete resolution of clinical symptoms and injury. Specular microscopy should be considered in future intraocular surgeries.

The Epidemiology of Cosmetic Treatments for Corneal Opacities in a Korean Population

PURPOSE: To describe etiologies and clinical characteristics of corneal opacities leading patients to seek cosmetic treatments. METHODS: The medical records of 401 patients who presented for cosmetic improvement in corneal opacities between May 2004 and July 2007 were retrospectively reviewed. The following parameters were analyzed: age, gender, cause of corneal opacity, time course of the corneal disease, associated diseases, prior and current cosmetic treatments, visual acuity, location and depth of the corneal opacity, and the presence of either corneal neovascularization or band keratopathy. A single practitioner examined all patients. RESULTS: The most common causes of corneal opacity were ocular trauma (203 eyes, 50.6%), retinal disease (62 eyes, 15.5%), measles (38 eyes, 9.5%), and congenital etiologies (22 eyes, 5.5%). Prior treatments included iris colored contact lenses (125 eyes, 31.1%) and corneal tattooing (34 eyes, 8.46%). A total of 321 of 401 eyes underwent cosmetic treatment for corneal opacities. The most common treatment performed after the primary visit was corneal tattooing (261 eyes, 64.92%). CONCLUSIONS: This is the first study to investigate the causes and clinical characteristics of patients presenting for cosmetic treatment of corneal opacities rather than for functional improvement. Various cosmetic interventions are available for patients with corneal opacities, and these should be individualized for the needs of each patient.

Preliminary Effects of Oral Uridine on the Ocular Surface in Dry Eye Patients

We designed a randomized, double blinded, 3-months controlled prospective clinical study to investigate effects of oral uridine on the ocular surface in dry eye patients. Twenty-seven patients who diagnosed as dry eye with lower than 5 mm of wetting in the Schirmer strip, with corneal epithelial erosion and who completely followed-up till 3 months were enrolled. Corneal-conjunctival fluorescein staining, non-anesthetic Schirmer test, impression cytology, and Ocular Surface Disease Index (OSDI) were evaluated in the experimental and placebo groups at the baseline, 1 and 3 months after start of medication in a double blinded manner. Fluorescein stain score of the cornea was markedly decreased in oral uridine group compared to the placebo group at 3 months after medication (P=0.032, Mann-Whitney U test). The Schirmer wetting score for the oral uridine group was significantly increased (P=0.001, Wilcoxon signed rank test) at 3 months and its difference between two groups was statistically significant (P=0.030, Mann-Whitney U test). OSDI scores were significantly decreased at 1 and 3 months in treatment group. Oral uridine is effective in treatment of dry eyes.

Methazolamide-induced Stevens-Johnson Syndrome

PURPOSE: To report three consecutive cases of methazolamide-induced Stevens-Johnson syndrome. CASE SUMMARY: We describe three patients who were all prescribed methazolamide for treatment of ophthalmologic conditions. A 29-year-old man and a 47- year-old woman were prescribed methazolamide (100 mg/day) for the treatment of central serous chorioretinopathy (CSCR). A 66-year-old woman was prescribed methazolamide (100 mg/day) for acute glaucoma of the left eye for approximately two weeks. After taking the methazolamide, three patients were showed the pururitic maculopapular rashes on the whole body and the vesicular eruptions of the oral mucosa and conjunctiva. On the basis of medication histories, characteristic skin lesions and mucosal involvement, we diagnosed all three patients with methazolamide-induced Stevens-Johnson syndrome. All three patients were hospitalized and treated with intravenous steroids and antihistamines. Two of the three cases showed conjunctival pseudomembranes. In two cases, the skin lesions worsened during the first week of treatment, and then resolved without complications over the next two to three weeks. The condition of the 47-year-old female patient deteriorated rapidly to toxic epidermal necrolysis due to sensitivity to sulfa antibiotics. HLA- A24, B59 and Cw1 were detected in all three cases. CONCLUSIONS: In 2008, domestic production of acetazolamide was halted in Korea. Because of this, methazolamide is expected to be prescribed by ophthalmologists more commonly than in previous years. Complete medical histories should be taken before prescribing methazolamide to patients. HLA typing should be conducted whenever possible to screen patients before prescription of methazolamide.

Orbital Cellulitis With Subperisoteal Abscess Secondary to Dental Extraction

PURPOSE: We report a case of orbital cellulitis with subperiosteal abscess secondary to dental extraction. CASE SUMMARY: A 55-year-old man presented to the emergency department with severe erythematous, painful swelling of the left periorbital area and the upper cheek after extraction of the left maxillary molar and premolar teeth. Computed tomography scan demonstrated marked periorbital inflammation and medial displacement of the left lateral rectus muscle by subperiosteal abscess extending along the lateral orbital wall. After a 10-day course of intravenous broad spectrum antibiotics and a 7-day course of oral prednisolone, he achieved complete resolution of all clinical symptoms and signs. CONCLUSIONS: Physicians should keep in mind that orbital complications may occur after oral surgery. A high level of suspicion in a patient with preceptal signs and a history of recent tooth infection or extraction is needed to avoid missing a diagnosis.

The Efficacy of Radial Optic Neurotomy for Central Retinal Vein Occlusion

PURPOSE: Central retinal vein occlusion (CRVO) often produces significant and permanent loss of vision in the affected eye, however there is no known effective treatment of CRVO. By restoration of retinal venous circulation via radial optic neurotomy (RON), we want to know the efficacy and complication of radial optic neurotomy were evaluated. METHODS: Ten eyes of 10 consecutive patients diagnosed as CRVO in Chonbuk national university hospital with best visual acuity 0.1 or worse underwent RON after a standard three-port vitrectomy as Opremcak's study. The average duration of the CRVO prior to RON was 2.4 months with a range of 1-9 months. RESULTS: The average follow-up was 5 months with a range of 1-12 months. Equal or better postoperative visual acuity, rapid resolution of intraretinal hemorrhage and restoration of normal retinal vasculature were noted in 8 of the 10 (80%) patients. 5 of the 10 (50%) patients had a final visual acuity of 0.1 or better. two patients achieved 0.3 final visual acuity, one patient achieved 0.6 final visual acuity. CONCLUSIONS: Compared with others without any treatment, RON may be a beneficial surgical procedure for severe CRVO and 0.1 or worse visual acuity. More cases and longer follow-up are needed to establish the indication, efficacy, and safety of RON in CRVO

Clinical Observations in Sensory Heterotropia

PURPOSE: We reviewed the clinical features and the treatment results of sensory heterotropia with the purpose of finding etiologic causes, factors influencing the the direction of deviation, and characterisitics of sensory deviations subsequent to cataract. METHODS: The charts of 134 patients diagnosed as sensory heterotropia in Chonbuk national university hospital between 1994 and 2001 were reviwed retrospectively. Visual acuity, the deviation in primary gaze, refractive error, the onset of vision loss and its etiology were analyzed. RESULTS: The major causative factor was cataract (29.1%) and anisometropic amblyopia (23.1%). When onset of visual impairment occurred between birth and the age of 5 years, 20 (33%) developed esotropia, and 41 (67%) developed exotrpia. In older children and adults, 9 (12%) developed esotropia, and 64 (88%) developed exotropia. A significant difference was noted between the age of onset and the type of horizontal strabismus (x2= 8.18, P0.05). While all of bilateral congenital cataract patients (4) had esotropia, unilateral congenital cataract patients showed exotropia to be predominated (4 of 5 eyes). The majority (17 of 21) of the sensory deviations subsequent to senile, traumatic cataract, uncorrected traumatic aphakia were converted from tropia to phoria, and showed the reduced angle of deviation after cataract operation or secondary IOL implantation. CONCLUSIONS: The age of onset of visual loss and the refractive error in the sound eye are thought to be the major factors influencing the direction of the deviation.

Two Cases of Treatment of Extreme Myopia using combined Anterior Chamber Phakic Intraocular Lens and Laser In Situ Keratomileusis

PURPOSE: For patient with extreme myopia outside the suspected limit of single procedure alone, we performed Lasik as a secondary procedure for the correction of residual refractive error following phakic IOL implantation. METHODS: First, we made a corneal flap using ACS(Bauch & Lomb surgical/Chirom vision, Irvine, CA) due to the potential risk of endothelial damage by cornea-IOL contact during the flap dissection. One month later, phakic IOLs, Nuvita MA20 (Bauch & Lomb surgical/Chiron vision, Irvine, CA) implantation were done, and 4 months after IOL implantation, stromal ablation was performed with the eximer laser by using previously formed flap. RESULTS: Preoperative spherical equivalent refraction was -25.0 D of Rt eye, -24.0 D of Lt eye, and preoperative visual acuity was 20/500 (best spectacle corrected visual acuity; BSCVA: 20/50) of Rt eye, 20/200 (BSCVA: 20/40) of Lt eye. Spherical equivalent refraction following phakic IOL implantation was -4.25 D of Rt eye, -3.75 D of Lt eye and refractive cylinder was -1.0 D cyl x90 A, visual acuity was 20/100 (BSCVA: 20/40) of Rt eye, 20/100 (BSCVA: 20/40) of Lt eye. Spherical equivalent refraction at the last examination following LASIK was -0.75 D of Rt eye, -0.5 D of Lt eye and visual acuity was 20/25 (BSCVA: 20/25) of Rt eye, 20/25 (BSCVA: 20/25) of Lt eye. CONCLUSIONS: Bioptics by combined anterior chamber phakic intraocular lens and laser in situ keratomileusis is one of the effective methods for patients with refractive error of extreme myopia outside the suspected limits of single procedure alone. Longer follow-up of large number of cases is needed to fully assess the safety and complications.