Nationwide Cross-sectional Study of Association between Pterygium and Alkaline Phosphatase in a Population from Korea

PURPOSE: We determined whether elevated serum alkaline phosphatase (ALP) was related to prevalence, location, type, length, and recurrence of pterygium in a population from the Republic of Korea.METHODS: A nationwide cross-sectional dataset, the Korean National Health and Nutrition Examination Survey (2008–2011), was used in this study. All participants were > 30 years of age and underwent the ALP test and ophthalmic evaluation (n = 22,359). One-way analysis of variance, the chi-square test, and Fisher's exact test were used to compare characteristics and outcomes among participants. Multivariable logistic regression was used to examine the possible associations between serum ALP levels and various types of pterygium. Data were adjusted for known risk factors for development of pterygium and ALP elevation (age, sex, residence, sunlight exposure, drinking, smoking, hypertension, diabetes, BMI, AST, ALT, vitamin D, and HDL).RESULTS: The overall prevalence of pterygium was 8.1%, and participants with pterygium had higher levels of serum ALP (p < 0.001). Participants with higher serum ALP had a significantly higher prevalence of all types of pterygium than those in the lower serum ALP quartiles. After adjusting for potential confounding factors, multivariate logistic regression analysis revealed that ALP was associated with the prevalence of pterygium (odds ratio [OR], 1.001; p = 0.038). Trend analysis between the OR and ALP quartiles revealed a linear trend in overall prevalence and in the intermediate type of pterygium. Subgroup analysis revealed a stronger correlation in participants > 50 years of age. One-way analysis of variance revealed an association between the size of pterygium and serum ALP quartile levels. Serum ALP was not associated with recurrence of pterygium.CONCLUSIONS: Increased serum ALP was associated with the prevalence and size of pterygium.

Endophthalmitis after Cataract Surgery in Korea: A Nationwide Study Evaluating Incidence and Risk Factors in a Korean Population

PURPOSE: To assess the nationwide rate of acute postoperative endophthalmitis (APE) after cataract extraction in Korea and to evaluate potential risk factors thereof. MATERIALS AND METHODS: Nationwide insurance claims data from July 2014 to June 2017 were reviewed. All patients with phacoemulsification or extracapsular/intracapsular cataract extraction were included. Exclusion criteria were combined glaucoma surgery or total vitrectomy or when the patient had a history of intraocular foreign body. RESULTS: In total, 1505103 cases (982203 patients) were included. APE developed in 953 cases (938 patients) with an overall incidence of 0.063%. After adjusting for possible confounding factors, male sex [odds ratio (OR) 1.42; 95% confidence interval (CI) 1.25–1.61; p<0.001], primary clinical setting, operations performed in non-major cities, usage of sutures (OR 2.82; 95% CI 2.13–3.74; p<0.001), anterior vitrectomy (OR 8.71; 95% CI 6.71–11.32; p<0.001), aphakic cataract surgery (OR 1.52; 95% CI 1.03–2.22; p=0.033), hypertension (OR 1.40; 95% CI 1.18–1.66; p<0.001), diabetes (OR 1.59; 95% CI 1.31–1.93; p<0.001), and chronic renal failure (OR 1.28; 95% CI 1.01–1.62; p=0.039) were found to be related to APE development. CONCLUSION: The incidence of APE after cataract extraction was consistent with reports from other studies. Additional research is needed to determine the relationship of newly found risk factors, such as hypertension, primary clinical setting, chronic renal failure, and usage of suturing, with APE development.

A Longitudinal Change of Spherical Equivalent in Anisometropic Children

PURPOSE: To demonstrate longitudinal refractive changes of anisometropia children. METHODS: This retrospective study included patients (or children) with anisometropia ≥ 1 diopters (D) for 5 years who visited our hospital between January 2013 and December 2014 with patients having annual refraction test data from 5-years-old to 10-years-old. RESULTS: A total of 37 children satisfied the inclusion criteria. Twenty-one children had hyperopic anisometropia and 16 children had myopic anisometropia. All hyperopic anisometropia and 12 myopic anisometropia children who had unilateral amblyopia were treated with occlusion therapy. The mean anisometropia at 5 years of age was 3.02 D and in the 37 children, the final degree of anisometropia was not significantly different between the 5-year-old and 10-year-old patients. In the high anisometropia and low anisometropia groups and in the myopia and hyperopia groups, the final degree of anisometropia was not significantly different at 5 years of age versus 10 years of age. CONCLUSIONS: In patients with anisometropia, spherical equivalent values did not show a significant difference when comparing 5-year-old versus 10-year-old patients and changes in the spherical equivalent values of eyes from both groups progressed to the same degree even if there was anisometropia in myopic and hyperopic patients.

Clinical Characteristics of Exodeviated Patients with Accomodative Esotropia and Hyperopia without Strabismus

PURPOSE: To evaluate the clinical characteristics of exodeviated patients with accomodative esotropia and orthophoric hyperopia. METHODS: We conducted a retrospective chart review of patients with accommodative esotropia and hyperopia who later developed exotropia and visited the Department of Ophthalmology of Wonju Severance Christian Hospital from January 1, 1997 to December 31, 2013. RESULTS: The study included 13 patients with a mean age of 4.1 years at initial referral. At the initial visit, nine patients (69.2%) had accommodative esotropia with a median of 25.5 PD esotropia at near gaze. Among the esotropic patients, four patients (44.4%) had unilateral amblyopia and five patients (55.6%) had bilateral amblyopia. The spherical equivalent was +6.09 D in the amblyopic eye and +5.63 D in the dominant eye. In the cases of bilateral amblyopia, the spherical equivalent was +5.875 D. Spontaneous consecutive exotropia developed at a mean age of 8.63 years (average follow-up of 56.38 months). Mean exodeviation was 10.33 PD. Among the four patients (30.8%) who were orthophoric at their initial visit, two patients (50%) had unilateral amblyopia and two (50%) had bilateral amblyopia. The spherical equivalents of the amblyopic eye and the dominant eye were +5.63 D and +3.13 D, respectively. In cases of bilateral amblyopia, a mean spherical equivalent of +5.50 D was observed. The mean age when exodeviation occurred was 10.75 years, which was 64 months after the initial visit. The average exodeviation was 6.5 PD. CONCLUSIONS: When treating accommodative esotropia and hyperopia, long-term observation is necessary since exodeviation could develop. Exotropia was successfully managed with spectacle correction. Further studies are needed for possible surgical intervention.

Eye Fixation in Patients with Dissociated Vertical Diviation

PURPOSE: To clinically determine the proportion of people with a fixed dissociating eye in patients with dissociated vertical deviation (DVD). METHODS: Medical records of 86 patients diagnosed with DVD in our department of ophthalmology from 2001 to November 2011 were retrospectively analyzed. RESULTS: Of the 71 patients, 25 (35.21%) showed a higher degree of dissociation in the fixating eye, 26 (36.62%) had higher dissociation in the non-fixating eye; 20 of 25 patients with a higher level of dissociation in the fixating eye and 22 of 26 patients with a higher level of dissociation in the non-fixating eye received surgical correction for DVD, such as superior rectus muscle recession or inferior oblique muscle anterior transposition. CONCLUSIONS: In DVD, the proportion of patients showing a higher level of dissociation in the fixating eye was significant. Patients with DVD require thorough evaluation; measurement of the level of dissociation and determination of the fixating eye is beneficial for management and surgical intervention.

Acute-Onset Vertical Strabismus in Adults

PURPOSE: To define the clinical characteristics of acute vertical strabismus in adults strabismus without known ocular and cranial external factors. METHODS: We performed a retrospective study of 72 adult patients who developed acute vertical strabismus without known ocular and cranial external factors such as trauma or operation and were followed up for at least 6 months. RESULTS: Undetermined cause (n = 41, 57%) was the most common etiology of acute vertical strabismus, followed by fourth cranial nerve palsy (n = 15, 20.8%), myasthenia gravis (n = 7, 9.7%), third cranial nerve palsy (n = 6, 8.3%), brain tumor (n = 2, 2.7%), and carotid-cavernous fistula (n = 1, 1.3%). The average vertical deviation at primary position was 7.2 prism diopter at initial visit. Thirty-eight (62.3%) patients recovered to orthophoria and 13 (21.3%) patients showed decreased level of diplopia. The average recovery period was 2.9 months. Ten cases remained as strabismus and 5 underwent surgery upon patient's request. CONCLUSIONS: Unknown cause was the most common diagonosis of adult acute vertical strabismus without known ocular and cranial external factors. In the present study, 62.3% of patients recovered to orthophoria and 83.6% recovered without surgical procedures.

The Effects of Stress on Intraocular Pressure and Lacrimal Secretion

PURPOSE: To evaluate the effects of psychosocial stress on intraocular pressure and lacrimal secretion. METHODS: Twenty normal adult volunteers (40 eyes) who had no history of systemic or ocular disease such as dry eye syndrome or glaucoma were recruited from clinical research participants. Heart rate, intraocular pressure and lacrimal secretion were measured after the Trier Social Stress Test (TSST) which induces psychosocial stress. The same measurements were taken 1 week later and the recorded measurements were considered as the control group. RESULTS: Heart rate was elevated significantly after the TSST, indicating psychosocial stress was induced by the TSST. Compared to stress resolution status, intraocular pressure and lacrimal secretion were increased after the TSST (p = 0.027, p = 0.011). Elevation of intraocular pressure and lacrimal secretion was statistically significant in males (p = 0.031, p = 0.007), but not significant in females (p = 0.336, p = 0.554). CONCLUSIONS: Psychosocial stress can increase intraocular pressure and lacrimal secretion.

Surgical Outcome of Vertical Rectus Muscle Recession in Hypertropia

PURPOSE: To determine the extent of vertical rectus muscle correction in hypertropia showing good prognosis. METHODS: A retrospective study was performed with a total of 16 patients who underwent superior or inferior rectus muscle recession surgery with a follow-up of more than 6 months. Vertical muscle recession of 1 mm per 2.5 to 3.0 prism diopters was performed according to the surgeon's discretion. RESULTS: At 1 week after surgical correction, undercorrection, orthophoria, and overcorrection was observed in 4, 7 and 5 cases, respectively. At the final examination, ocular deviation was decreased in the undercorrected cases and maintained orthophoric except in 1 case where only a small amount of deviation recurred. However, in the cases of postoperative overcorrectionn, ocular deviation increased; 2 cases required surgical correction for consecutive hypertropia. CONCLUSIONS: When performing vertical rectus muscle recession in primary hypertropia, the amount of correction for orthophoria or undercorrection should be determined.

Postoperative Exotropic Drift: Comparison of Surgical Methods Combined with Lateral Rectus Muscle Recession in Exotropia

PURPOSE: To assess the difference in the change of postoperative ocular alignment in intermittent exotropia corrected by horizontal muscle transposition or inferior oblique muscle recession together with lateral rectus muscle recession. METHODS: A total of 110 patients with intermittent exotropia with a follow-up period of more than 6 months after lateral rectus muscle recession were enrolled in the present study. The patients who received lateral rectus muscle recession only were classified as group 1, patients who received both lateral rectus muscle recession and horizontal muscle vertical transposition in both eyes were classified as group 2, and patients who underwent lateral rectus muscle and inferior oblique muscle recession were classified as group 3. The differences in postoperative ocular alignment among the patient groups were compared. RESULTS: Among the 3 groups, group 2 demonstrated the smallest amount of esotropic deviation in mean postoperative ocular alignment measured 1 day and 1 month after surgery. There was no significant difference among the groups in the mean postoperative ocular alignment and mean amount of exotropic drift at 6 months. The difference in the amount of postoperative exotropic drift 1 year after surgery among the 3 groups was statistically significant. The largest amount of postoperative exotropic drift was observed in group 1. CONCLUSIONS: In correcting intermittent exotropia, the largest amount of postoperative exotropic drift was observed in patients who received only lateral rectus muscle recession. By contrast, the smallest amount of postoperative exotropic drift was observed in patients who received lateral rectus muscle recession with vertical transposition of the horizontal muscle.

Refractive Change Caused Silicone Oil Adhesion to the Intraocular Lens Following Nd:YAG Posterior Capsulotomy

A 32-year-old female who had undergone the silicone oil removal procedure presented with visual disturbance in her left eye. Several months previous, she had cataract surgery in a private clinic, and a month later she had a Nd:YAG laser procedure for posterior capsulotomy. The slit-lamp examination revealed silicone oil droplets that had adhered to the intraocular lens where the posterior capsulotomy was performed. She had experienced high myopia as a manifestation of the resulting refractive changes. We replaced the previous intraocular lens with a new acrylic intraocular lens with resulting improvement to her vision. Here we report the case of a female patient with a history of silicone oil removal surgery where the resulting silicone bubbles had not been removed thoroughly and remained in the vitreous cavity. These bubbles subsequently adhered to the intraocular lens following YAG laser posterior capsulotomy, resulting in refractive changes. We recommend that implanting a silicone intraocular lens in anyone with a history of the silicone oil removal procedure or who has a possible history of silicone oil use should be avoided.