Comparison of Longitudinal Changes in Refractive Error of Hyperopic Children with or without Refractive Accommodative Esotropia.

We investigated longitudinal changes in the spherical equivalent refractive error (SE) in hyperopic children with or without refractive accommodative esotropia (AccET). A total of 456 patients met the inclusion criteria: 190 (41.7%) in the hyperopic control group and 266 (58.3%) in the AccET group. All patients received at least 3 years of follow-up after spectacle prescription. Subgroups were divided according to age when spectacles were prescribed, presence of amblyopia, or initial SE. Longitudinal changes in SE in children with hyperopia showed a gradual decrease, although SE of younger children with AccET increased over the first 4 years and then decreased thereafter. SE in eye with higher SE was tended to decrease significantly in patient with Acc ET than hyperopic control group (group × time p = 0.015). Amblyopic eyes showed a greater decreased in SE compared with non-amblyopic eyes, but it was not statistically significant (p = 0.07). SE was significantly decreased in children with more hyperopia (≥ 3 D) compared with children with less hyperopia (<3 D) (p = 0.008). Emmetropization of hyperopia was faster in hyperopic patients without AccET and could be affected by the age of the initial spectacles prescription, initial amount of SE, or presence of amblyopia.

Surgical Outcomes of Patients with Diagnostic Preoperative Monocular Occlusion in Intermittent Exotropia.

We evaluated surgical outcomes of bilateral rectus (BLR) recession in patients with intermittent exotropia who underwent diagnostic monocular occlusion. Records of patients with intermittent exotropia who were preoperatively examined one-hour monocular occlusion and underwent BLR recession were reviewed retrospectively. Patients were classified into two groups based on change in exodeviation angle: responders (≥5 change in prism diopters [PD] after occlusion) or non-responders (<5 PD change after occlusion). BLR recession amount was determined by maximal angle deviation after occlusion tests in both groups. Overall follow-up period was 38.81 ± 24.09 months for non-responders (n = 106) and 38.52 ± 19.87 months for responders (n = 142) (p = 0.766). There was no difference in deviation before monocular occlusion between the two groups. Mean angle of deviation at distance (24.23 ± 6.27 PD) and near fixation (25.46 ± 6.78 PD) increased to distance (29.95 ± 6.43 PD) and near deviation (32.15 ± 6.17 PD) after occlusion in the responder group. At postoperative 1 year, surgical success rate was higher in responders (71.1%) than in non-responders (52.8%) (p = 0.003). Kaplan-Meier survival analysis revealed significantly higher surgical success in responders (p = 0.001, log-rank test). Preoperative diagnostic monocular occlusion in patients with intermittent exotropia can influence surgical outcomes by identifying the latent exodeviation angle.

Intravitreal itraconazole inhibits laser-induced choroidal neovascularization in rats.

Choroidal neovascularization (CNV) is a major cause of severe visual loss in patients with age-related macular degeneration (AMD). Recently, itraconazole has shown potent and dose-dependent inhibition of tumor-associated angiogenesis. We evaluated the anti-angiogenic effect of itraconazole in a rat model of laser-induced CNV. After laser photocoagulation in each eye to cause CNV, right eyes were administered intravitreal injections of itraconazole; left eyes received balanced salt solution (BSS) as controls. On day 14 after laser induction, fluorescein angiography (FA) was used to assess abnormal vascular leakage. Flattened retinal pigment epithelium (RPE)-choroid tissue complex was stained with Alexa Fluor 594-conjugated isolectin B4 to measure the CNV area and volume. Vascular endothelial growth factor receptor 2 (VEGFR2) mRNA and protein expression was determined 1, 4, 7, and 14 days after intravitreal injection by quantitative RT-PCR or Western blot. VEGF levels were analyzed by enzyme-linked immunosorbent assay (ELISA). Intravitreal itraconazole significantly reduced leakage from CNV as assessed by FA and CNV area and volume on flat mounts compared with intravitreal BSS (p = 0.002 for CNV leakage, p<0.001 for CNV area and volume). Quantitative RT-PCR showed significantly lower expression of VEGFR2 mRNA in the RPE-choroid complexes of itraconazole-injected eyes than those of BSS-injected eyes on days 7 and 14 (p = 0.003 and p = 0.006). Western blots indicated that VEGFR2 was downregulated after itraconazole treatment. ELISA showed a significant difference in VEGF level between itraconazole-injected and BSS-injected eyes on days 7 and 14 (p = 0.04 and p = 0.001). Our study demonstrated that intravitreal itraconazole significantly inhibited the development of laser-induced CNV in rats. Itraconazole had anti-angiogenic activity along with the reduction of VEGFR2 and VEGF levels. Itraconazole may prove beneficial for treating CNV as an alternative or adjunct to other therapies.

Multilobular lacrimal sac diverticulum presenting as a lower eyelid mass.

Lacrimal sac diverticulum is a rare condition, and its various symptoms complicate differential diagnosis. We present cases of a peculiar type of lacrimal diverticulum. A 5-year-old girl and a 50-year-old woman presented with a protruding mass inferior to the medial canthus. Each lacrimal system was patent to irrigation. The masses compressed and distorted the lacrimal passage and had no apparent connection with the lacrimal sac in dacryocystography or computed tomography. Surgical exploration and complete excision of the masses were completed. Each patient had an inverted Y- and an inverted V-shaped multilobular cystic mass that was pathologically confirmed as a lacrimal sac diverticulum. Lacrimal sac diverticula may rarely take the form of a multilobular cyst and can present as a lower lid mass. We speculate that an abnormality in lacrimal embryogenesis resulted in multiple blind pouches, a peculiar type of lacrimal sac diverticulum.

The effect of cataract surgery on diurnal intraocular pressure fluctuation.

PURPOSE: We examined prospectively the effects of cataract surgery on diurnal intraocular pressure (IOP) fluctuation in patients without glaucoma. MATERIALS AND METHODS: We evaluated 42 eyes from 42 patients without glaucoma that underwent clear corneal phacoemulsification and intraocular lens implantation by the same surgeon without complications. The diurnal IOP was measured using a Goldmann applanation tonometer the day before surgery and at least 4 weeks after surgery. The diurnal IOP was measured from 9 AM to 11 PM every 2 hours by the same clinician. RESULTS: The mean age of the 14 men and 28 women was 69.7+/-7.6 (SD) years. The mean preoperative IOP was 12.2+/-2.5 mm Hg. Postoperatively, the mean IOP was 10.7+/-2.1 mm Hg. The maximum IOP was significantly decreased from the mean preoperative level of 13.7+/-2.7 mm Hg to 12.3+/-2.7 mm Hg at follow-up. The minimum IOP was also significantly decreased from 10.9+/-2.7 mm Hg to 9.7+/-2.1 mm Hg. Cataract surgery reduced IOP significantly at all measurement time points (P<0.05). However, there was no significant difference in the range of IOP before (2.8+/-1.3 mm Hg) and after (2.7+/-1.5 mm Hg) surgery (P=0.498). CONCLUSIONS: We found a significant decrease in IOP after cataract surgery in nonglaucoma patients. However, change of diurnal IOP fluctuation after surgery was not statistically different. These results can be used as baseline data for diurnal IOP fluctuation studies in glaucoma patients after cataract surgery.

Comparison of actual vacuum pressures at the end of 3 phacoemulsification tips in swine eyes.

PURPOSE: To compare the actual vacuum pressure at the end of an aspiration bypass system (ABS) phaco tip and a conventional tip in conditions similar to those during human cataract surgery. SETTING: Kangbuk Samsung Hospital, Seoul, Korea. METHODS: A 4.0 mm diameter rubber eraser ball was inserted in a phacoemulsified swine eye and engaged to a phaco tip. With a vacuum pressure of 300 mm Hg, the eraser ball was pulled in the opposite direction with the phaco tip. The pulling power separating the eraser ball from the phaco tip was measured using the volume of water dripped into a container connected to the eraser ball. Measurements were taken with an Infiniti ABS tip and 2 conventional tips: Sovereign (conventional tip S) and Infiniti (conventional tip I). Measurements were taken alternatively at random in the same eye. RESULTS: The mean pulling power was 17.35 mL +/- 5.01 (SD) with conventional tip S and 16.85 +/- 4.45 mL with conventional tip I. The mean pulling power of the ABS tip was 13.35 +/- 4.32 mL, which was a mean 20.8% lower than that of conventional tip I (P = .016) and 23.1% lower than that of conventional tip S (P = .010). CONCLUSIONS: The actual vacuum pressure of the phaco tip was significantly influenced by the presence of the ABS hole. To compensate for the decrease in actual vacuum pressure, surgeons should be aware of the characteristics of the ABS tip being used and change the standard settings accordingly.

Changes in astigmatism after surgery for epiblepharon in highly astigmatic children: a controlled study.

PURPOSE: To evaluate changes in astigmatism after corrective surgery in highly astigmatic epiblepharon patients compared with nonepiblepharon patients. METHODS: We retrospectively reviewed the charts of 37 patients with epiblepharon and 35 patients without epiblepharon, but with initial astigmatism > or =2 D. Demographic data and preoperative data for best-corrected visual acuity, degree of astigmatism, and astigmatism axis were obtained. Postoperative data were collected at 1, 3, 6, and 12 months and at 2 years. RESULTS: The mean age at surgery was 5.1 +/- 1.5 years. The mean amount of cylinder was 3.27 +/- 0.97 D before surgery and 2.62 +/- 1.07 D at 2 years after surgery. Linear mixed measures analysis, which was used to compare the mean cylinder between the epiblepharon and nonepiblepharon groups, showed significant group-time interaction (p < 0.01). Patients who were younger and had greater initial cylinder showed significantly greater decreases in the cylinder during 2 years of follow-up (p < 0.05). CONCLUSIONS: Significant astigmatic changes were found after surgical correction in epiblepharon patients with 2 D of astigmatism or greater compared with nonepiblepharon patients, and these changes were more significant in patients of younger age and with greater astigmatism. A high prevalence of epiblepharon during the critical period for visual development warrants physician interest in early surgery and visual rehabilitation in highly astigmatic epiblepharon patients.

Acquired nasolacrimal duct obstruction in children.

PURPOSE: To study the clinical characteristics of acquired nasolacrimal duct (NLD) obstruction in Korean children. METHODS: The records of 38 patients under the age of 15 years who had undergone silicone intubation or dacryocystorhinostomy (DCR) for acquired NLD obstruction were evaluated. Patients who had congenital NLD obstruction or a history of NLD obstruction due to trauma were excluded. RESULTS: The mean age of the patients was 3 years (range, 1-8 years). The causes of the NLD obstruction were epidemic keratoconjunctivitis (EKC) in 32 patients, herpetic blepharitis in one, and idiopathic in five. In patients with a history of EKC, symptoms were observed at a mean age of 12.7 months (range, 3-51 months). These patients demonstrated multifocal features of obstruction, unlike those in the idiopathic group. Silicone intubation was performed in 32 patients, external DCR in three, and endonasal DCR in three. The lacrimal procedures were beneficial in 36 of the 38 patients. The mean follow-up period was 7.6 months. CONCLUSIONS: Acquired NLD obstruction in children was mostly caused by EKC in our study. It is important to suspect NLD obstruction in children with persistent epiphora that develops after EKC.

T-cell lymphoma presenting as painful ophthalmoplegia.

PURPOSE: To present a case of peripheral T-cell lymphoma presenting as painful ophthalmoplegia. METHODS: A 61-year-old woman presented with a 2-week history of headache and eyeball pain. Examination showed mild exophthalmos, complete ophthalmoplegia, and ptosis of the left eye. Under the impression of nonspecific orbital inflammation, she was treated with oral prednisone with initial response. Two months later, she revisited the clinic with exacerbated symptoms. Anterior orbitotomy and incisional biopsy was performed for the inferior rectus muscle lesion. RESULTS: Histopathologic examination revealed an infiltrate of atypical lymphoid cells between degenerative muscle bundles. It was consistent with peripheral T-cell lymphoma. A metastatic workup was performed without any evidence of extraorbital tumor. The patient was recommended to be treated with chemotherapy, however, refused to take the treatment. The patient died of progression of the disease in a month. CONCLUSIONS: T-cell lymphoma in the orbit can present as painful ophthalmoplegia and take a rapid clinical course. The disease should be regarded as one of the differential diagnosis for painful ophthalmoplegia refractory to corticosteroid therapy.

Eyelid incision for dacryocystorhinostomy in Asians.

PURPOSE: Dacryocystorhinostomy via an eyelid incision has been described in Western literature. This study was undertaken to confirm that eyelid incision for dacryocystorhinostomy is suitable in Asians, because Asians have anatomic features that differ from those of Westerners. METHODS: We performed dacryocystorhinostomy with an eyelid incision along skin wrinkles or relaxed skin tension lines in 57 eyelids of 49 patients from July 2003 to December 2004. The medical records of the patients were reviewed retrospectively. RESULTS: Postoperative scars were easily camouflaged by wrinkles or relaxed skin tension lines of the eyelid without major complications. CONCLUSIONS: An eyelid incision can be used for dacryocystorhinostomy in Asians, regardless of the lack of a definite lower eyelid crease and the presence of epicanthus.

Effect of thermal preconditioning before excimer laser photoablation.

The purposes of this study were to assess the expression patterns of heat shock proteins (Hsps), after eyeball heating or cooling, and to elucidate their relationships with corneal wound healing and intraocular complications after excimer laser treatment. Experimental mice were grouped into three according to local pretreatment type: heating, cooling, and control groups. The preconditioning was to apply saline eyedrops onto the cornea prior to photoablation. Following photoablation, we evaluated corneal wound healing, corneal opacity and lens opacity. Hsp expression patterns were elucidated with Western blot and immunohistochemical staining. The heating and cooling groups recovered more rapidly, and showed less corneal and lens opacity than the control group. In the heating and cooling groups, there were more expressions of Hsps in the cornea and lens than in the control group. These results were confirmed in the Hsp 70.1 knockout mouse model. Our study showed that Hsps were induced by the heating or cooling preconditioning, and appeared to be a major factor in protecting the cornea against serious thermal damage. Induced Hsps also seemed to play an important role in rapid wound healing, and decreased corneal and lens opacity after excimer laser ablation.