The Clinical Outcome of Endoscopic Silicone Tube Intubation for Congenital Nasolacrimal Duct Obstruction

PURPOSE: To evaluate the surgical results and clinical effectiveness of silicone tube intubation through Hasner's valve under intranasal endoscopic guidance in children with congenital nasolacrimal duct obstruction (CNDO). METHODS: The present study enrolled a total of 58 eyes of 46 children over 12 months of age diagnosed with CNDO in the Department of Ophthalmology, Inje University College of Medicine from 2003 to 2010. Patients who had previously undergone ineffective probing or had a combination of an anatomical abnormality such as secondary nasolacrimal duct obstruction were also included. The silicone tube was intubated through the Hasner's valve and observed with intranasal endoscopy; tube retention time was planned for at least 12 weeks. RESULTS: A total of 20 eyes were previously probed preoperatively (mean 1.7 times). After the average follow-up period of 13.5 months, the overall success of silicone intubation was 57 of 58 eyes (98%). In one failed eye, nasolacrimal obstruction was already combined preoperatively, and unintentional tube removal by the patient occurred within one week. Silicone tube reintubation was performed after four months, and CNDO symptoms improved. CONCLUSIONS: Intranasal endoscopic observation to ensure the passage of a silicone tube through Hasner's valve decreases anatomical injury. When considering patient age and former treatment, silicone tube intubation with intranasal endoscopic observation could produce desirable results with a higher success rate.

Comparison of Inferior Oblique Myectomy, Recession, and Anterior Transposition in Unilateral Congenital Superior Oblique Palsy

PURPOSE: To compare the clinical outcomes of myectomy, recession, and anterior transposition (AT) of the inferior oblique muscle in congenital unilateral superior oblique palsy. METHODS: A total of 40 patients who were followed for longer than three months postoperatively and, who underwent inferior oblique myectomy, recession, or AT were evaluated retrospectively. RESULTS: We compared the result of inferior oblique myectomy, recession, and AT in congenital unilateral superior oblique palsy. The decreased amounts of inferior oblique overaction (IOOA) were 2.24+/-0.67, 2.00+/-0.76, 3.00+/-1.15 for myectomy, recession, and AT, respectively. Improvement of superior oblique underaction was 0.80+/-0.66, 0.86+/-0.83, 1.00+/-0.58, and the changes in hyperdeviation were 10.96PD, 8.25PD, 14.86PD for myectomy, recession, and AT, respectively. There were no significant differences among the surgical methods. The proportion of patients who showed IOOA in the contralateral eye after operation were 20.0% in myectomy, 25.0% in recession, and 57.1% in AT. CONCLUSIONS: The efficacies of myectomy, recession, and AT of inferior oblique muscle in the congenital unilateral superior oblique palsies showed no significant differences among methods. The AT group tended to show a larger effect than did the other methods, along with a high development percentage of contralateral eye IOOA. Based on these results, AT of the IO shoud be selectively chosen in more severe cases.

A Case of Granular Cell Tumor in Form of Ciliary Body Tumor

PURPOSE:To report a case of a granular cell tumor in the form of cilliary body tumor. CASE SUMMARY: A 42-year-old women visited our clinic with blurred vision of the right eye, which began was 1 month earlier ago. Her medical history was unremarkable. Slit-lamp examination revealed a ciliary body tumor and complicated cataract due to a mass lesion. For treatment, an excisional biopsy of the ciliary body tumor and phacoemulsification were performed. The pathologic finding confirmed the diagnosis of a granular cell tumor. There was no evidence of a recurrent lesion of the tumor at the 6-month postoperative follow-up. CONCLUSIONS: We confirmed a granular cell tumor in the form of a cilliary body tumor based on pathologic findings.

Ophthalmic Artery Occlusion With Third Cranial Nerve Paresis Associated With Acute Internal Carotid Artery Occlusion

PURPOSE: We report a case of ophthalmic artery occlusion with third nerve paresis in the left eye due to acute occlusion of the left ICA. CASE SUMMARY: A 37-year-old man visited our emergency room with "black out" in the left eye, headache, and nausea. The corrected visual acuity was 20/25 in the right eye, and hand motion in the left eye. In the left eye, a relative afferent papillary defect was noted, with an intraocular pressure of six mmHg. Twenty prisms of exotropia in the primary position was observed, and ocular motor examination revealed limitations of supraduction, infraduction, and adduction in the left eye, suggesting third nerve palsy of the left eye. Fundus examination revealed a pale retina in the macula of the left eye. Brain MRI demonstrated multifocal faint low densities in the left caudate nucleus as well as the frontal and parietal lobes. CT angiography and four-vessel angiography demonstrated complete occlusion in the proximal part of the left internal carotid artery ICA.

A Case of Anti-GQ1b-Positive Atypical Miller Fisher Syndrome With Pupil Involvement

PURPOSE: To report a case of atypical Miller Fisher syndrome with pupil involvement. CASE SUMMARY: An 18-year-old woman visited our clinic with a headache and blurred vision. Ophthalmic examination revealed a corrected visual acuity of 20/20 in both eyes, with both pupils dilated to 7.5 mm. There was a loss of light reflex and near reflex in both eyes. Ocular motor examination revealed bilateral abduction, and supraduction limitation, and mild adduction limitation. Neurological examination demonstrated hyporeflexia without ataxia. Brain CT, brain MRI, nerve conduction test, CSF study, and thyroid function tests were normal. The serologic anti-GQ1b IgG test was positive. CONCLUSIONS: We confirmed a case of atypical Miller Fisher syndrome with an anti-GQ1 antibody test that had pupil involvement, areflexia, and acute ophthlamoparesis.