Comparison between Modified Bilateral Lateral Rectus Recession and Augmented Unilateral Recession-resection for Convergence Insufficiency Exotropia

PURPOSE: To compare the surgical outcomes between modified bilateral lateral rectus muscle (BLR) recession and augmented unilateral recession-resection (R&R) for the convergence insufficiency intermittent exotropia (IXT). METHODS: 37 patients with convergence insufficiency IXT were divided into two groups: 13 patients (underwent BLR recession) and 24 patients (underwent unilateral R&R). Success was defined as within 10 prism diopters (PD) at distance and near, and within 10 PD of the difference between them at postoperative 12 months. RESULTS: After the patch test, the preoperative distance deviation angle in the BLR group was 29.9 ± 8.4 PD, and the near deviation angle was 42.3 ± 9.7 PD; the difference between them was 12.5 ± 3.2 PD. In the R&R group, the preoperative distance deviation angle was 26.7 ± 5.8 PD, and the near deviation angle was 41.5 ± 7.4 PD; the difference between them was 14.8 ± 4.3 PD (p = 0.235, p = 0.987, and p = 0.123). At the 12-month follow-up in the BLR group, the distance angle was 3.8 ± 5.1 PD, and the near deviation angle was 4.9 ± 6.1 PD; the difference between them was 2.9 ± 5.9 PD. In the R&R group, the postoperative distance deviation angle was 4.7 ± 6.1 PD, and the near deviation angle was 7.9 ± 6.6 PD; the difference between them was 3.65 ± 5.1 PD (p = 0.708, p = 0.162, and p = 0.632, respectively). The surgical success rate did not differ significantly between groups at 12 months postoperatively (76.9%: BLR group and 70.8%: R&R group; p = 0.690). CONCLUSIONS: Modified BLR recession showed a similar surgical success rate to augmented unilateral R&R, and was effective in reducing both distance and near exodeviation, and in decreasing the difference between distance and near deviation in convergence insufficiency IXT.

Clinical Features of Acquired Paralytic Strabismus

PURPOSE: The purpose of our study was to evaluate the cause of acquired third, fourth, and sixth nerve palsy while also establishing recovery rates and important factors for recovery. METHODS: A retrospective chart review was performed for 92 patients who visited the ophthalmologic department of Konyang University Hospital with acquired third, fourth, and sixth nerve palsy from March 2015 to February 2016. Recovery rates and factors for recovery were evaluated in only 66 patients who received first ocular exam within 2 weeks of onset and who were followed up for at least 6 months. Complete recovery was defined as both complete recovery of the angle of deviation and the restoration of eye movement in all directions. For the degree of ocular motor restriction, −4 was defined as not crossing the midline and −2 was defined as 50% eye movement. The degree of ocular motor restriction was analyzed from −1/2 to 4. RESULTS: The fourth nerve was affected most frequently (n = 37, 40.2%), followed by the sixth cranial nerve (n = 33, 35.9%), the third cranial nerve (n = 18, 19.6%), and a combination of 2 or more cranial nerves (n = 4, 4.3%). Vasculopathy (n = 44, 47.8%) was the most common etiology, followed by trauma (n = 14, 15.2%), idiopathic (n = 13, 14.1%), inflammation(n = 10, 10.9%), neoplasm (n = 9, 9.8%), and aneurysm (n = 2, 2.2%). Complete recovery rate occurred for 66.7% (n = 44) of patients, and the overall recovery rate (i.e., at least partial recovery) was 86.3% (n = 57). Significant factors for complete recovery were the initial deviation angle and the limitation of extraocular movement (p < 0.001, p = 0.005, respectively, according to univariate analysis). CONCLUSIONS: In this study, paralytic strabismus due to vasculopathy was the most common etiology, and a lower degree of initial deviation resulted in an improved complete recovery rate. In addition, a high overall recovery rate was possible through quick diagnosis and early treatment of cranial nerve palsy.

Antielevation Syndrome after Bilateral Anterior Transposition of the Inferior Oblique Muscles

No abstract available.

Diagnostic Availability of Blind Spot Mapping for Ocular Torsion

PURPOSE: To evaluate diagnostic the usefulness of blind spot mapping in measuring ocular torsion changes and to investigate the correlations of inferior oblique muscle overaction (IOOA) and excyclotorsion measurements using fundus photographs and blind spot mapping in patients with secondary IOOA. METHODS: Eleven patients (12 eyes; IOOA group) diagnosed with secondary IOOA were evaluated for ocular movement, fundus photograph and Humphrey standard automated perimetry, and 10 patients (20 eyes; control group) were subjected to the same tests. An ocular movement examination was performed to evaluate IOOA, and fundus photograph and Humphrey standard automated perimetry were used to measure the ocular torsion. Inferior oblique myectomy or recession was performed along with horizontal strabismus surgery, and preoperative and postoperative IOOA and ocular torsion measurements were compared between the groups. RESULTS: In the IOOA group after surgery, the IOOA decreased from +2.42 ± 0.63 to +0.50 ± 0.52, the ocular torsion decreased from +14.15 ± 3.60° to +7.47 ± 1.65° (p < 0.001) on fundus photographs, and from +12.19 ± 1.62° to +9.69 ± 1.75° (p = 0.061) in Humphrey standard automated perimetry. The control group showed a mean ocular torsion of 7.44 ± 1.62° on fundus photographs and +7.24 ± 1.28° on Humphrey standard automated perimetry. CONCLUSIONS: The usefulness of blind spot mapping when the ocular torsion was measured in IOOA patients was considered low, due to the weak correlation between IOOA and extorsion; preoperative and postoperative ocular torsion amount values were not significantly different.

Identification of a Fibrillin-1 Gene Mutation in a Monozygotic Twin Presenting with Bilateral Juvenile-onset Ectopia Lentis

No abstract available.

The Long-Term Refractive Change after Cataract Surgery in Myopic Patients with a History of LASIK

PURPOSE: To evaluate the long-term change of postoperative refraction after cataract surgery in patients with a history of LASIK. METHODS: A retrospective chart review was performed on 40 eyes of 28 patients who had undergone cataract surgery with a history of LASIK, and 40 eyes of 31 patients who had undergone cataract surgery without LASIK. We evaluated preoperative target refraction, and postoperative refraction during the 2-year follow-up period. RESULTS: In the group with a history of LASIK, the target refraction was -1.00 +/- 0.98 D, the 2-month postoperative spherical equivalent was -0.53 +/- 1.92 D, and the 2-year postoperative spherical equivalent was -1.03 +/- 1.84 D. In the group with cataract surgery only, the target refraction was -1.44 +/- 1.06 D, the 2-month postoperative spherical equivalent was -1.07 +/- 1.27 D, and the 2-year postoperative spherical equivalent was -0.97 +/- 1.28 D. The difference in mean spherical equivalent at 2 months postoperatively and at 2 years postoperatively between the 2 groups was statistically significant (p = 0.037). The difference in mean spherical equivalent preoperatively and 2 years postoperatively between the 2 groups was statistically significant (p = 0.002). In the group with cataract surgery only, the postoperative refraction shifted to hyperopic refractive power, and was statistically significant. In the group with a history of LASIK, there were no statistically significant differences between preoperative and postoperative refraction. There were no statistically significant differences according to the cataract type in the group with a history of LASIK. The greater the myopic preoperative spherical equivalent was, the shorter the duration between LASIK and cataract surgery, which was significant in the group with a history of LASIK. CONCLUSIONS: The long-term refractive change after cataract surgery was statistically significant between the cataract surgery after LASIK group and the cataract surgery alone group.

Idiopathic Orbital Inflammation Presenting as Unilateral Dacryoadenitis in a Child

PURPOSE: To report a case of idiopathic orbital inflammation presenting as unilateral acute dacryoadenitis in a child. CASE SUMMARY: A nine-year-old boy presented with painful swelling and redness in the right upper eyelid and temporal conjunctiva without systemic symptoms for five days. Acute orbital cellulitis was suspected but did not respond to systemic antibiotics. An orbital computed tomogram and magnetic resonance imaging revealed a diffusely enlarged and inflamed right lacrimal gland. The patient showed dramatic response to systemic corticosteroids, and acute dacryoadenitis due to idiopathic orbital inflammation was diagnosed. Treatment with oral corticosteroids for two months resolved the inflammation. No relapse was observed during four months of follow-up. CONCLUSIONS: Although rare, acute dacryoadenitis as a localized nonspecific orbital inflammation should be considered in the differential diagnosis of acute orbital cellulitis in pediatric patients.

A Case of Basosquamous Carcinoma of the Eyelid

PURPOSE: To report a rare case of basosquamous carcinoma of the eyelid, an aggressive tumor with a higher tendency for recurrence and metastasis. CASE SUMMARY: An 87-year-old woman presented with a painful mass and bloody exudates at the left lateral lower eyelid. Four years previous, the patient was diagnosed with basosquamous carcinoma of the left lower eyelid after biopsy at another hospital. At that time, she was unable to receive operation because she had suffered from a serious heart condition. With time, the left lower eyelid mass continued to grow and symptoms and signs of pain and bloody exudates appeared. The patient underwent surgery for complete tumor resection and repair and the biopsy of a specimen showed tumor-free margins and no metastasis to distal sites. CONCLUSIONS: Basosquamous carcinoma is a subtype of basal cell carcinoma with aggressive behavior and a higher tendency for recurrence and metastasis. However, our case showed no recurrence with no metastasis to the nearby lymph nodes, vessels, or nerves. We report a case of basosquamous carcinoma of the eyelid at old age that was cured after operative resection.

Bilateral Central Retinal Vein Occlusion in Patient with Disseminated Intravascular Coagulation

PURPOSE: To report a case of bilateral central retinal vein occlusion (CRVO) as one of the initial signs of disseminated intravascular coagulation (DIC). CASE SUMMARY: A 33-year-old woman with a history of pregnancy-induced thrombotic thrombocytopenic purpura presented to our hospital with bilateral visual loss. On her initial visit, visual acuity was counting fingers at 30 cm in both eyes. Based on the findings of a funduscopic examination, the patient was diagnosed with bilateral CRVO. Laboratory tests confirmed the diagnosis of DIC combined with thrombotic thrombocytopenic purpura (TTP). Plasma exchange and transfusion of cryoprecipitate with fresh frozen plasma was performed. The ocular fundus findings did not improve. Despite medical treatment, the patient's systemic condition deteriorated and she died of metabolic acidosis two weeks later. CONCLUSIONS: Bilateral central retinal vein occlusion occurred as a sign of aggravation of preexisting TTP and progression to DIC in the presented case. In patients with severe bilateral retinal venous changes, there should be a very high level of suspicion for presence or progression of systemic disease, with the possibility of effective early systemic evaluation and therapy.