The Effect of Preoperative Occlusion Therapy on Long-term Outcome after Surgery for Early-onset Exotropia

PURPOSE: To investigate the effect of preoperative part-time occlusion therapy on long-term surgical success in early-onset exotropia. METHODS: The medical records of patients who underwent surgery for exotropia with onset before the first year of age and who were followed for ≥3 years were reviewed. Patients were divided into two groups according to the degree of compliance with part-time occlusion therapy: the good compliance group (>50% adherence rate) and the poor compliance group (≤50% adherence rate). Surgical success was defined as orthophoria to exodeviation less than 10 prism diopters both at distance and near. The level of postoperative stereopsis was compared between the two study groups among total enrolled patients and among those with constant exotropia. RESULTS: Of the 51 patients, 26 were assigned to the good compliance group and the remaining 25 patients to the poor compliance group. The surgical success rate was significantly higher in the good compliance group than in the poor compliance group (80.8% vs. 52.0%, p = 0.040). Among 24 constant exotropia patients (12 patients for each group), the success rate was insignificantly higher in the good compliance group than in the poor compliance group (75.0% vs. 58.3%, p = 0.448). The good compliance group had a better level of stereopsis than the poor compliance group (p = 0.045 for all 44 patients, p = 0.020 for 19 patients with constant exotropia). CONCLUSIONS: Preoperative part-time occlusion therapy was useful for improving the surgical outcome of early-onset exotropia and postoperative stereopsis.

Long-Term Changes of Hyperopic Refractive Error in Refractive Accommodative Esotropia

PURPOSE: To analyze the long-term changes of hyperopic refractive error in patients with refractive accommodative esotropia. METHODS: We retrospectively reviewed the medical records of 54 patients with accommodative esotropia who underwent at least 36 months of follow-up and had hyperopia more than +1.50 diopter (D). The patients were divided into groups according to the degree of hyperopia: +1.50~ or =+3.00~ or =+5.00 D, the age of their first hyperopic glasses prescription: under two-years old, between two to four-years old and older than four years old, whether or not they had amblyopia, the degree of astigmatism: or =0.75- or =1.25 D and divided into two groups according to the degree of stereopsis: 400 sec. The divided groups were than retrospectively reviewed if they influenced the refractive error at the third year of follow-up using Fisher's exact test, paired t-test, Wilcoxon's signed-ranks test, Mann-Whitney U test, Kruskal-Wallis H test, and ANOVA (p < 0.05). RESULTS: The mean follow-up period was 103.72 +/- 41.82 months for refractive accommodative esotropia. Patients with a greater initial hyperopic refractive err or showed a significant tendency towards emmetropization with a higher rate of hyperopic decrease (p < 0.001), regardless of the hyperopic refractive error. Statistical differences were not observed in patients who started wearing glasses after four-years old, patients with amblyopia, patients with a large degree of astigmatism, and patients with poor stereoacuity. CONCLUSIONS: Long-term changes of hyperopic refractive error in accommodative esotropia showed a significant decrease when initial hyperopic refractive error was high. Wearing hyperopic glasses at an older age and visual functions such as amblyopia, large degree of astigmatism, and poor stereoacuity may influence emmetropization.

The Analysis of Prognostic Factors in Patients with Decompensated Liver Cirrhosis Admitted to the Medical Intensive Care Unit / 대한구급학회지

BACKGROUND: Patients with decompensated liver cirrhosis usually resulted in admission to the intensive care unit (ICU) during hospitalization. When admitted to the ICU, the mortality was high. The aim of this study is to identify multiple prognostic factors for mortality and to analyze the significance of prognostic survival model with each scoring system in patients with decompensated liver cirrhosis who was admitted to the ICU. METHODS: From January 2008 to December 2008, 60 consecutive patients with decompensated liver cirrhosis were admitted in the ICU and retrospectively reviewed. Prognostic models used were Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), model for end-stage liver disease with incorporation of serum sodium (MELD-Na), acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA). The predictive prognosis was analyzed using the area under the receiver's operating characteristics curve (AUC). RESULTS: The median follow up period was 20 months, and ICU mortality was 17% (n = 10). A total of 24 patients (40%) died during the study period. The average survival of five prognostic models was related with the severity of the disease. All of the five systems showed significant differences in the cumulative survival rate, according to the scores on admission, and the MELD-Na had the highest AUC (0.924). Multivariate analysis showed that bilirubin and albumin were significantly related to mortality. CONCLUSIONS: The CPT, MELD, MELD-Na, APACHE II, and SOFA may predict the prognosis of patients with decompensated liver cirrhosis. The MELD-Na could be a better prognostic predictor than other scoring systems.