Orbital Emphysema Causing Eye Movement Restriction Without Orbital Fractures Due to Compressed Air Injury

PURPOSE: The authors experienced a case of orbital emphysema causing eye movement disorder following conjunctival tear without any orbital wall fractures after exposure to compressed air. CASE SUMMARY: A 28-year-old man's left periorbital area was injured while working with compressed air. There was marked lid swelling on the left side with palpable crepitus. The patient had an exotropia and hypertropia of the left eye. In addition, the extraocular movement of the left eye was restricted on upgaze without nausea and vomiting. On slit-lamp examination, conjunctival partial laceration and subconjunctival air bubbles adjacent to the conjunctival laceration could be seen. Orbital computed tomography showed air in the periorbital and retrobulbar region of the left eye and no evidence of orbital fracture. On examination 4 days after the primary repair of the conjunctival laceration, the patient completely recovered without any complication. CONCLUSIONS: Orbital emphysema following a conjunctival laceration caused by compressed air without any orbital wall fractures can cause restriction of eye movement.

Antibiotics Susceptibility in Bacterial Keratitis and Proper Initial Treatment

PURPOSE: The present study aims to determine the common pathogens involved in the etiology of bacterial keratitis and to analyze not only the antibiotic susceptibility of bacterial isolates from patients with bacterial keratitis but also the propriety of initial treatment. METHODS: A retrospective study of 161 eyes in 161 patients with bacterial keratitis, who were diagnosed by cultures from 2000 to 2011, was performed. Causative bacteria and antibiotic susceptibility were evaluated in consecutive 6-year periods. RESULTS: The most common bacteria was the pseudomonas species in the 2 time periods tested and cefazolin with tobramycin was the most commonly used antibiotic (125 cases, 77.6%) for initial treatment of bacterial keratitis. In vitro testing showed gram-negative susceptibility to tobramycin and ciprofloxacin was over 70%, gram-positive susceptibility to cephalothin and vancomycin was 100% and there was no significant difference between the 2 time periods tested. Eight cases had resistance to the initial treatment, but only 1 case showed treatment failure. CONCLUSIONS: Antibiotics used for initial treatment of bacterial keratitis were able to obtain a proper effect but several cases showed bacterial resistance to antibiotics. Thus, continued testing is essential to monitor for antibiotic resistance.

A Case of IgG4-Related Sclerosing Disease Involving the Eyelid in an Idiopathic Sclerosing Myositis Patient

PURPOSE: To report a case of IgG4-related sclerosing disease involving the eyelid in an idiopathic sclerosing myositis patient. CASE SUMMARY: A 51-year-old woman presented with swelling, redness, and tenderness of the left lower eyelid of 1 month duration had taken an immunosuppressant for idiopathic sclerosing myositis. Eye movements showed limitation all directions but there was no exophthalmos. A palpable mass was noted in the left lower eyelid. The left extraocular muscles were hypertrophied but the lacrimal gland was normal on orbital magnetic resonance imaging. IgG4-related sclerosing disease was confirmed by immunostained biopsy from the left lower eyelid, showing infiltration of IgG4-positive lymphoplasmacytic cells. The patient was given oral steroids and an immunosuppressant and the symptoms did not recur for at least 7 months. CONCLUSIONS: IgG4-related sclerosing disease involving ocular adnexa usually consists of bilateral lacrimal gland involvement. Additionally, the orbital soft tissue involvement without dacryoadenitis is rare. The authors of the present study report a case of IgG4-related sclerosing disease involving the left lower eyelid in an idiopathic sclerosing myositis patient and should be considered in the differential diagnosis of eyelid masses.

Effect of Hormone Replacement Therapy on Dry Eye Syndrome in Postmenopausal Women: A Prospective Study

PURPOSE: To evaluate the effects of conjugated hormone replacement therapy (HRT) on dry eye syndrome in postmenopausal women. METHODS: Thirty-six healthy postmenopausal women (72 eyes) were included in this three-month prospective study. Schirmer test, tear film break-up time (BUT), fluorescein staining score and symptom score were performed on all patients at the time of enrollment, one month and three months after initiation of HRT. All patients received HRT consisting of conjugated estrogen and progesterone taken orally in a continuous combined regimen. RESULTS: Symptom score significantly decreased from 2.10+/-0.79 before HRT to 1.32+/-0.84 after one month and to 0.88+/-0.67 after three months (p<0.001). In addition, tear film BUT measurements significantly increased from 6.04+/-2.54 seconds to 7.99+/-2.43 seconds after one month and to 8.93+/-2.20 after three months (p<0.001). The fluorescein staining score was 0.94+/-0.71 before HRT and decreased to 0.42+/-0.60 after one month and to 0.22+/-0.42 after three months (p<0.001). CONCLUSIONS: Hormone replacement therapy consisting of conjugated estrogen and progesterone significantly improved the symptoms and signs of dry eye syndrome in postmenopausal women.

Cataract and Refractive Surgery in ; a Survey of KSCRS Members From 1995~2006

PURPOSE: This purpose of this report was to study trends in cataract and refractive surgeries conducted during the past twelve years and to compare results to previous reports from the ASCRS and New Zealand (NZ) in order to forecast future medical services. METHODS: We surveyed members of the Korean Society of Cataract and Refractive Surgery (KSCRS) every year from 1995 to 2006, and studied changes in cataract and refractive surgeries (RS). RESULTS: The duration of hospitalization has been gradually decreasing to the point that a one day hospitalization following surgery has become common. The rate of topical anesthesia use has significantly increased since 1998. Sutureless incision methods are now commonly practiced. The use of acryl IOL as an optic material has been gradually increasing for cataract surgeries. KSCRS members showed an interest in the special intraocular lenses as multifocal IOL. While Excimer laser PRK was the most popular refractive surgery during the first stage, KSCRS members increasingly prefer LASIK to the Excimer laser PRK. Regression of the corrected visual acuity, dry eye, night halo, and flashes were the most common complications following refractive surgeries. Medical disputes related to PRK and LASIK have been gradually increasing throughout the study period. CONCLUSIONS: We confirm that the KSCRS practice styles for cataract and RS are similar to those of the ASCRS and NZ. We infer a world-wide trend from the comparison of these three societies.

Choroidal Ischemia and Serous Macular Detachment Associated with Severe Postoperative Pain

To report the association of a unilateral serous macular detachment with severe postoperative pain. A 71-year-old woman presented with a sudden decrease in vision in the right eye, seven days after a total knee replacement arthroplasty. The patient's history was unremarkable except for a severe pain greater than the visual analog scale of 8 points for about 2 days after surgery. Retinal examination showed a well differentiated serous detachment that was about 3.5 disc diameter in size and located in the macular area. Fluorecein angiography and indocyanine green angiography showed delayed perfusion of the choriocapillaris without leakage points in the early phase and persistent hypofluorescence with pooling of dye in the subretinal space in the late phase. There was a spontaneous resolution of the serous detachment and the choroidal changes with residual pigment epithelial changes. Severe postoperative pain may influence the sympathetic activity and introduce an ischemic injury with a focal, choroidal vascular compromise and secondary dysfunction of overlying RPE cells in select patients.

The Complications after Intravitreal Injection of Triamcinolone Acetonide

PURPOSE: This study was performed to ascertain the complications including intraocular pressure (IOP) elevation and cataract progression, can possibly arise after 4.0 mg triamcinolone (TA) is injected into the vitreous cavity in the treatment of macular diseases, and to analyze the influential factors. METHODS: This retrospective study comprises 325 eyes of 289 patients followed for over 6 months. All patients had undergone an intravitreal TA injection between March 2004 and September 2005. Visual acuities and intraocular pressures had been measured preoperatively, and at 1 day, 7 days, 1, 3, 6, 12, and 18 months postoperatively. Likewise, changes in crystalline lenses were observed at the same periods. RESULTS: The maximum IOP was significantly increased compared with preoperative IOP (P<0.0001). The average pressure measured at 1, 3, 6, and 18 months postoperatvely, was significantly increased (P<0.05). IOP elevation was observed in 52 eyes (16%). This complication was improved after treatment in most cases, but 2 eyes (0.62%) required surgical repair. Cataract progression was observed at 56 eyes (21.50%); posterior subcapsular opacity accounted for the highest proportion (42 eyes, 16.1%) and 6 eyes (2.3%) required surgery. Younger age (P=0.005) and the presence of diabetes mellitus (P=0.035) were significantly associated with TA-induced IOP elevation and cataract progression, respectively. CONCLUSIONS: Although intravitreal TA injection is effective in treating macular diseases, careful consideration of complications such as IOP elevation and cataract progression and their related risk factors must be taken when choosing the proper treatment.

A Case of Plexiform Neurofibroma with Severe Ptosis and Proptosis

PURPOSE: We present a case of plexiform neurofibroma that extensively invaded cranial and temporal bone, eyelid, orbit and uveal tissues, showing signs of severe ptosis and proptosis and symptoms of headache and ocular pain. METHODS: A 24-year old woman visited our clinic with pain and progressive proptosis, which had persisted for 2 weeks. She had a history of congenital neurofibromatosis. There were multiple Cafe-au-lait spots on her extremities, trunk, and face. Also, she had severe ptosis in her upper left eyelid, proptosis, and a distorted and asymmetric facial form. The cornea was markedly edematous. An enhanced computed tomography scan revealed an uncertain circumscribed soft tissue mass with enlargement of the eyeball and orbit, coupled with sphenoid wing dysplasia and herniation of the dura mater into the orbit due to expansion and bony destruction of the superior orbital wall. Under general anesthesia, the patient underwent excision and histopathologic biopsy of intraocular neurofibroma through evisceration. RESULTS: The tumor had black-colored multilobular nodules whose dimensions were 1.5x1.2x0.4 cm. After a histopathologic examination, the tumor was determined to be a pigmentary hamartoma of the uvea. Based on the clinical and histologic findings, we diagnosed the patient with plexiform neurofibroma with type I neurofibromatosis.

Refractive Surgery 2004 in Korea

PURPOSE: This study investigates both the current situation and future trends in the field of refractive surgery in Korea. METHODS: Members of the Korean Society of Cataract and Refractive Surgery (KSCRS) have been annually surveyed regarding cataract and refractive surgery since 1995. The 2004 annual survey, which consisted of 58 multiple-choice questions, was mailed in May 2004 to 322 KSCRS members; fifty-four (16.8%) members responded. Data from the 2004 survey was compared with that of previous annual surveys and similar studies from the USA. RESULTS: The respondents indicated that patients in their forties accounted for the highest percentage (57%) of subjects, and LASIK accounted for the highest percentage (82%) of refractive surgeries. Degeneration of corrected vision, night halo, and glare accounted for a high proportion of the complications arising after refractive surgery. LASIK was the preferred method for treating myopia less than -12 diopters, while phakic IOL was preferred for myopia more than -12 diopters. Lastly, more respondents indicated that they had experienced legal problems associated with PRK or LASIK than the previous year. CONCLUSIONS: LASIK remains the refractive surgery procedure of choice, although wavefront-guided ablation is gaining in popularity. Approximately half of the respondents indicated they used MMC in their refractive surgeries.

Clinical Comparison of Autorefractor versus Retinoscopic Refraction in Children according to the Age

PURPOSE: We analyzed the difference in values between noncycloplegic and cycloplegic autorefraction and refraction, as measured by ophthalmologist, in children according to age. METHODS: We classified the 84 children (153 eyes) whose best corrected visual acuity was better than 0.6 into four groups according to age. The first age group ranged from 29 to 57 months (36 eyes); the second age group ranged from 58 to 75 months (47 eyes); the third age group ranged from 76 to 95 months (36 eyes); and the fourth age group ranged from 96 to 121 months (34 eyes). The children were examined with an autorefractometer (Canon Auto Ref RK-2) and a retinoscope before and after cycloplegia. RESULTS: The children in all age groups tend to show more myopia in autorefraction than refraction regardless of cycloplegia. Also, differences in spherical component and spherical equivalents in noncycloplegic autorefraction and cycloplegic refraction were regarded as significant statistically (P<0.05) in all age groups. However, in all groups, none of the refractive values in cycloplegic autorefraction and refraction were statistically significant. CONCLUSION: Refraction measurement should be recommended for cycloplegic refraction in children. It is suggested that cycloplegic autorefraction could be useful for the refraction partially.