Clinical Characteristics of Rhinogenic Optic Neuropathy Associated with Paranasal Sinus Disease

Purpose@#We describe the clinical features of patients with rhinogenic optic neuropathy caused by paranasal sinus disease. @*Methods@#Nine patients (11 eyes) diagnosed with rhinogenic optic neuropathy were retrospectively reviewed. All exhibited sphenoid or posterior ethmoid sinus lesions on magnetic resonance imaging and corresponding visual acuity or visual field defects. Patients with other causes of optic neuropathy were excluded. We recorded symptoms and symptom durations, best-corrected visual acuity, relative afferent pupillary defects, color vision test results, fundus morphology, optical coherence tomographic data, and visual field test results before and after endoscopic sinus surgery. @*Results@#The involved sinuses were the sphenoid alone (five eyes), posterior ethmoid alone (two eyes), and both (four eyes). The underlying sinus pathologies included six eyes with sinusitis and three with mucoceles. The best-corrected visual acuity exceeded 20/40 for nine eyes, the color vision test results were normal for all eyes, and relative afferent pupillary defects were noted in three eyes of unilaterally affected patients. The Humphrey visual field test revealed paracentral scotomas (three eyes, 27.3%), nasal defects related to the vertical meridian (three eyes, 27.3%), arcuate defects (two eyes, 18.2%), and a horizontal altitudinal defect (one eye, 9.1%). Six patients underwent endoscopic sinus surgery. Three patients who underwent early interventions (within 4 weeks of onset) experienced full visual recovery. @*Conclusions@#In patients with suspected optic neuropathy, a paranasal sinus lesion adjacent to the optic canal should be considered. Prompt diagnosis and early intervention (endoscopic sinus surgery) are recommended for patients with rhinogenic optic neuropathy to reduce the incidences of visual loss and visual field defects.

Clinical Characteristics of Rhinogenic Optic Neuropathy Associated with Paranasal Sinus Disease

Purpose@#We describe the clinical features of patients with rhinogenic optic neuropathy caused by paranasal sinus disease. @*Methods@#Nine patients (11 eyes) diagnosed with rhinogenic optic neuropathy were retrospectively reviewed. All exhibited sphenoid or posterior ethmoid sinus lesions on magnetic resonance imaging and corresponding visual acuity or visual field defects. Patients with other causes of optic neuropathy were excluded. We recorded symptoms and symptom durations, best-corrected visual acuity, relative afferent pupillary defects, color vision test results, fundus morphology, optical coherence tomographic data, and visual field test results before and after endoscopic sinus surgery. @*Results@#The involved sinuses were the sphenoid alone (five eyes), posterior ethmoid alone (two eyes), and both (four eyes). The underlying sinus pathologies included six eyes with sinusitis and three with mucoceles. The best-corrected visual acuity exceeded 20/40 for nine eyes, the color vision test results were normal for all eyes, and relative afferent pupillary defects were noted in three eyes of unilaterally affected patients. The Humphrey visual field test revealed paracentral scotomas (three eyes, 27.3%), nasal defects related to the vertical meridian (three eyes, 27.3%), arcuate defects (two eyes, 18.2%), and a horizontal altitudinal defect (one eye, 9.1%). Six patients underwent endoscopic sinus surgery. Three patients who underwent early interventions (within 4 weeks of onset) experienced full visual recovery. @*Conclusions@#In patients with suspected optic neuropathy, a paranasal sinus lesion adjacent to the optic canal should be considered. Prompt diagnosis and early intervention (endoscopic sinus surgery) are recommended for patients with rhinogenic optic neuropathy to reduce the incidences of visual loss and visual field defects.

Comparison of Efficacies in Treating Astigmatism between Toric Intraocular Lens Implantation and Limbal Relaxing Incision

PURPOSE: To compare the effectiveness of toric intraocular lens (IOL) implantation and monofocal IOL implantation with a limbal relaxing incision (LRI) for correcting astigmatism in the Korean population. METHODS: The medical records of 79 patients (100 eyes) with corneal astigmatism over 1.25 diopters (D) who underwent toric IOL implantation (toric group; 54 eyes), monofocal IOL implantation with a concurrent LRI (LRI group; 24 eyes), or monofocal IOL implantation without correcting astigmatism (control group; 22 eyes), were retrospectively reviewed. For subgroup analyses, the three groups were subdivided according to preoperative astigmatic severity under 2.5 D. Visual, refractive, and keratometric outcomes were compared 2 and 6 months postoperatively. RESULTS: The uncorrected distance visual acuity was at least 20/25 (0.1 logMAR) in 64.8%, 41.7%, and 27.3% of the toric, LRI, and control group eyes, respectively at 2 months after surgery. The toric group had the greatest refractive cylindrical error change (toric group, −2.48 ± 1.84 D to −0.98 ± 0.92 D; LRI group, −2.02 ± 1.03 D to −1.65 ± 0.86 D; control group, −1.69 ± 0.88 D to −1.49 ± 0.60 D; p < 0.001) and the LRI group showed the greatest mean corneal cylindrical error change (toric group, 2.40 ± 1.33 D to 2.23 ± 1.42 D; LRI group, 1.86 ± 0.44 D to 1.29 ± 0.55 D; control group, 1.60 ± 0.39 D to 1.35 ± 0.60 D; p = 0.025). The 85 eyes with moderate corneal astigmatism (between 1.25 D and 2.5 D) were under evaluation. The toric group showed the highest mean refractive cylindrical change (0.97 ± 0.66 D; p < 0.001), followed by the LRI group (0.53 ± 0.87 D; p = 0.046). CONCLUSIONS: Both surgical techniques significantly reduced astigmatism and had comparable visual outcomes. Toric IOL implantation was more reliable for correcting astigmatism than monofocal IOL implantation with a concurrent LRI regardless of the preoperative astigmatic severity. Both procedures were effective in reducing astigmatism in eyes with moderate corneal astigmatism.

A Case of a Cyst Containing a Parasite and Misdiagnosed as a Dermoid Cyst

PURPOSE: To introduce a case of a cyst containing a parasite misdiagnosed as a dermoid cyst, which is to the best of our knowledge, the first report in Korea of a parasite in a cyst located at the medial side of the orbit. CASE SUMMARY: A 31-year-old male visited the hospital with a 2-year history of a slowly growing mass at the medial side of the right orbit. The patient had a history of mass excision in the same location 18 years previously, however, biopsy was not performed at that time. Orbital computed tomography and magnetic resonance imaging revealed a 5.0 × 1.4 × 1.8 cm³ well-defined T1 high signal intensity unilocular cyst, thus our first impression was a dermoid cyst. The cyst was surgically removed with anterior orbitotomy. The cyst ruptured during the operation, and thus complete aspiration of the cystic fluid and in situ irrigation with antibiotics were performed. Histopathological examination revealed a fragmented adult parasite worm with chronic granulomatous change. CONCLUSIONS: A differential diagnosis for orbital cyst based on clinical and radiological results is difficult. Thus, histopathological confirmation is required. A cyst containing a parasite located in the orbit has rarely been reported. A full examination of all infected patients must be conducted for parasite infection.

Factors Affecting Long-term Myopic Regression after Laser In Situ Keratomileusis and Laser-assisted Subepithelial Keratectomy for Moderate Myopia

PURPOSE: High myopia is known to be a risk factor for long-term regression after laser refractive surgery. There have been few studies about the correction of moderate myopias that did not need retreatment after long-term follow-up. We evaluated 10 years of change in visual acuity and refractive power in eyes with moderate myopia after laser refractive surgery. METHODS: We included patients that had undergone laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) to correct their myopia and that had at least 10 years of follow-up. We evaluated the stability of visual acuity in terms of safety, efficacy, and refractive changes at examinations 6 months and 1, 2, 5, 7, and 10 years after surgery. RESULTS: The study evaluated 62 eyes (36 eyes in LASIK patients and 26 eyes in LASEK patients). In both groups, the efficacy index tended to decrease, and it was consistently higher in the LASEK group compared to the LASIK group over the 10 years of follow-up. The safety index improved over 10 years and was always higher than 0.9 in both groups. The difference between the spherical equivalent at 6 months postoperatively and later periods was statistically significant after 5, 7, and 10 years in both groups (LASIK, p = 0.036, p = 0.003, and p < 0.001, respectively; LASEK, p = 0.006, p = 0.002, and p = 0.001, respectively). Ten years after surgery,26 eyes (66.7%) in the LASIK group and 19 eyes (73.1%) in the LASEK group had myopia greater than 1 diopter. In comparison with the thickness at 6 months postoperatively, central corneal thickness was significantly increased after 5, 7, and 10 years in both LASIK and LASEK groups (LASIK, p < 0.001, p < 0.001, and p < 0.001, respectively; LASEK, p = 0.01, p < 0.001, and p < 0.001, respectively). CONCLUSIONS: Moderately myopic eyes showed progressive myopic shifting and corneal thickening after LASIK and LASEK during 10 years of follow-up. We also found that early refractive regression may indicate the long-term refractive outcome.