The difference of surgical outcomes between manifest exotropia and esotropia.

PURPOSE: To determine the factors that affect ocular alignment and binocular sensory functions after strabismus surgery and compare surgical outcomes between manifest exotropia (XT) and esotropia (ET). METHODS: In a retrospective study, 41 XT and 17 ET patients who had undergone strabismus surgery were recruited. Information on type and duration of strabismus, age at onset of deviation and surgery, pre- and postoperative strabismus deviation angles, and binocular sensory functions including stereoacuity and macular fusion capacity was recorded. RESULTS: In all patients, the ocular alignment and binocular sensory functions improved with time following surgery. Residue strabismus deviation angles (≦ 10 prism diopters) at postoperative 1 month determined the final successful ocular alignment. In patients with final excellent binocular sensory functions, XT group restored macular fusion capacity and stereoacuity at postoperative 1 month, but ET group regained macular fusion capacity at postoperative 1 month and then restored stereoacuity at postoperative 3 months. Though XT patients showed better pre- and postoperative stereoacuity than ET patients, patients with successful ocular alignment had an odd of 4.5 in XT group and 22.5 in ET group to achieve excellent and fair binocular sensory functions. CONCLUSION: Surgical correction of strabismus could improve ocular alignment and binocular sensory functions in patients with manifest strabismus, regardless of onset age, strabismus duration, or type. Postoperative 1-month status may help to predict the final motor and sensory outcomes. ET patients would benefit more final successful ocular alignment and excellent binocular sensory functions from early surgery and maintaining postoperative small deviation angle than XT patients.

Correlation between periventricular leukomalacia and retinopathy of prematurity.

PURPOSE: To investigate the correlation between periventricular leukomalacia (PVL) and retinopathy of prematurity (ROP), which are complications of perinatal and postnatal hypoxic-ischemic insults in premature infants. METHODS: In this retrospective case series study, from 1996 to 2008, after excluding cases with follow-up of less than 3 months, we reviewed medical charts of babies who had gestational age (GA) less than 30 weeks or birthweight (BW) less than 2000 g. A total of 195 patients were diagnosed with ROP and/or PVL and were enrolled in this analysis. We investigated the correlation between ROP and PVL with Pearson chi-square test and evaluated BW, GA, and Apgar scores at 1 minute and 5 minutes after birth as risk factors by independent t test. RESULTS: There were no significant differences in the prevalence of PVL between patients who received ROP treatment and those who did not receive ROP treatment. The BW was significantly lower in patients with PVL than in patients without PVL. Gestational age, BW, and Apgar scores significantly differed between patients who did and did not receive retinal treatment for ROP. CONCLUSIONS: Periventricular leukomalacia did not increase the severity of ROP or requirement of ROP treatment. Birthweight, GA, and Apgar scores were the principal factors that determined the necessity of ROP treatment.

Review of 20 years' clinical experience with retinoblastomas in southern Taiwan.

BACKGROUND: Retinoblastomas are the most common malignant intraocular tumor of childhood. We describe the survival outcomes and prognostic factors of patients with a retinoblastoma receiving primary treatment at our hospital over the last 20 years. METHODS: A retrospective series study of 30 retinoblastoma cases treated from January 1, 1987 to August 31, 2006 was conducted from a review of medical records and histopathological sections. Variables, including age at onset, laterality, treatment modalities, treatment delay, and optic nerve invasion, were analyzed to elucidate the prognostic factors associated with cumulative survival. RESULTS: Most of the cases had an advanced retinoblastoma, and 23 patients received enucleation treatment. The average period of delay for treatment was 5.37 months after discovery of the disease. The overall cumulative survival rate was 83.08%. Patients with optic nerve invasion had a significantly lower survival rate (60.0%) than those without optic nerve involvement (94.75%). Treatment delay in excess of 6 months was correlated with tumor invasion of the optic nerve. CONCLUSIONS: Tumor invasion of the optic nerve is the most significant prognostic factor for surviving a retinoblastoma. Delayed treatment increases the risk of optic nerve invasion. Parental awareness of both the risk of this consequence and the significance of early treatment is vital to achieving improved survival rates.

The effects of CAM vision stimulator for bilateral amblyopia of different etiologies.

BACKGROUND: To evaluate the association between bilateral amblyopia and the effects of CAM vision stimulator. METHODS: This retrospective study was carried out between January 1994 and July 2004. The 105 children enrolled were all younger than 7 years old and had bilateral amblyopia. All children wearing full-correction glasses regularly received CAM vision stimulation once per week. The patients' age, initial best corrected visual acuity (BCVA), final BCVA, and the number of CAM sessions needed to achieve a visual acuity (VA) > or = 0.8 were recorded. RESULTS: The major cause of bilateral amblyopia was refractive error. In this study, the types of refractive error were classified as astigmatism (> 2.0D, 61 cases), hyperopia (> 3.0D, 17 cases), and myopia (> 4.0D, 12 cases). The myopic group showed significantly poorer visual outcomes than the other children after CAM treatment (p < 0.05). However, older children patients had better initial BCVA, and the hyperopic patients had the better outcomes in this study. CONCLUSIONS: CAM treatment for bilateral amblyopia can achieve satisfactory improvement in 3 months in most instances. The myopic group and children younger than 4 years old had worse visual outcomes after CAM treatment.

Simultaneous bilateral cataract surgery in general anesthesia patients.

BACKGROUND: The aim of this study was to evaluate the indications, safety, benefits, disadvantages and advantages, and the visual outcomes for simultaneous bilateral cataract surgery (SBCS) under general anesthesia. METHODS: This retrospective case review pertained to a period spanning from June 1998 through June 2005 inclusively, and comprised of 27 consecutive patients (54 eyes) that underwent simultaneous bilateral cataract surgery under general anesthesia at the Kaohsiung Chang Gung Memorial Hospital, Taiwan. Surgery modalities included phacoemulsification, extracapsular cataract extraction, lens aspiration and intraocular lens implantation. Outcome measures included postoperative best correct visual acuity (BCVA) as well as intraoperative and postoperative complication rates. Due to the bipolas distribution of the age, we arbitrarily divided our cases into younger group (Group Y, younger than 20 years old) and older group (Group O, equal to or older than 20 years old). RESULTS: Thirty-eight of the 54 eyes (60% in the younger group and 76.5% in the older group), featuring measured preoperative and postoperative BSCVA, achieved improved visual acuity following SBCS. Two eyes (5.9% in the older group) demonstrated poorer visual acuity postoperatively than preoperatively. Seven patients (40% in the younger group and 17.6% in the older group) were not able to express VA due to their particular medical conditions such as mental disease and young age. Intraoperative and postoperative complication rates were similar to those cited in previous reports of analogous but unilateral extracapsular surgery and simultaneous bilateral cataract surgery. Endophthalmitis did not arise in any of the eyes operated upon and reported on herein, and no examples of bilateral complications that resulted in visual loss occurred in our patients. CONCLUSION: SBCS could be a good choice when cataract surgery needs to be performed under general anesthesia. The relative benefits of SBCS under general anesthesia could eclipse the associated enhanced risks of this surgery.

Prevention of myopia progression with 0.05% atropine solution.

AIM: The aim of this study was to evaluate the efficacy of 0.05% atropine solution for controlling myopia progression in school-aged children. RESULTS: This retrospective, case-control study enrolled myopic school-aged children who had presented at Kaohsiung Chang Gung Memorial Hospital (Kaohsiung, Taiwan) from 2001 to 2004. A group of 57 children (30 boys, 27 girls; 6-12 years of age) with regular follow-up was divided into a subgroup of 21 children (12 boys, 9 girls) who received atropine eyedrops (0.05%) every evening, and a subgroup of 36 children (18 boys, 18 girls), who remained untreated, served as controls. The changes in refractive status of 114 eyes in 57 children were collected and compared for patients treated with 0.05% atropine eyedrop and those without medical control. The initial spherical equivalent of refractive status range was between -0.5 and -5.5 D. Mean myopia progression for the group of patients treated with 0.05% atropine eyedrop (n = 21) was -0.28 +/- 0.26 D/year, significantly lower than that of the control group of -0.75 +/- 0.35 D/year (36 patients; P < 0.001). The 0.05% atropine group had a significant lower ratio of uncontrolled myopia, that progressed greater than -0.50 D in 1 year, relative to the controls (16.7% versus 77.8%; P < 0.001). CONCLUSIONS: The results of this study demonstrate that, with regular instillation, topical 0.05% atropine is an effective agent for controlling myopia progression in a majority of school-aged children for at least a period of 1 year.

Nosocomial postoperative endophthalmitis: a 14-year review.

BACKGROUND: The objective of this study was to evaluate the incidence, predisposing surgery, management and final visual outcome of postoperative endophthalmitis over a 14-year period at one institute. METHODS: This retrospective study reviewed all intraocular operations performed between 1 January 1991 and 31 August 2004 at Chang Gung Memorial Hospital, Kaohsiung Medical Center, to determine the incidence of nosocomial postoperative endophthalmitis and the characteristics of patients who developed this condition. RESULTS: The overall incidence of postoperative endophthalmitis after intraocular surgery was 0.19% (56 out of 30,219). Postoperative endophthalmitis developed in 56 eyes in 56 patients during the study period. The condition developed after cataract surgery in 46 eyes, after penetrating keratoplasty in 6 eyes, after filtering surgery in 2 eyes, after secondary intraocular lens implant in 1 eye, and after vitrectomy in 1 eye. Postoperative endophthalmitis was culture-positive in 31 cases (55%). The most frequent organism isolated was coagulase-negative Staphylococcus. Factors associated with better visual acuity outcomes included low virulence of isolated pathogen, initial visual acuity of counting fingers or better, and history of cataract surgery compared with other intraocular surgery. CONCLUSION: The overall incidence of endophthalmitis after intraocular surgery was 0.19%. The results of this 14-year review from a local medical center may serve as a source of comparison for other centers and future studies.

Surgical results of persistent fetal vasculature.

BACKGROUND: To evaluate the surgical results of patients with persistent fetal vasculature (PFV), also known as persistent hyperplastic primary vitreous (PHPV). METHODS: From 1991 to 2001, a retrospective, noncomparative study of 7 eyes of 7 patients diagnosed with PFV was conducted. In each case, type of anterior and/or posterior PHPV findings, preoperative testing, surgical procedures, and visual outcomes were obtained from the records. Follow-up ranged from 12 to 43 months, with a mean of 15 months. RESULTS: Of the 7 eyes, one (14%) had strictly anterior PFV, 1 (14%) had strictly posterior PFV, and 5 (71%) had components of both anterior and posterior disease. Initial lens aspiration only was performed in 3 (43%) eyes. Initial vitrectomy only was performed in 1 eye (14%). Initial lensectomy and vitrectomy was performed in 3 (42.8%) eyes. The reoperation rate was 43% for membrane reproliferation, glaucoma, vitreous hemorrhage, and retinal detachment. Final best-corrected visual acuity ranged from light perception only to 20/70 on the Snellen chart. CONCLUSIONS: Functional vision is possible in selected patients. However, poor final visual outcome despite adequate anatomic success were noted in this study. The poor outcomes might have been due to patients delaying vitrectomy until retinal detachment developed or that the patients had poor compliance with postoperative ocular rehabilitation.

Orbital exenteration for secondary orbital tumors: a series of seven cases.

BACKGROUND: Exenteration is indicated in patients with malignant neoplasms of orbital contents. It entails the removal of the eyeball together with its extraocular muscles and other soft tissues. Exenterations can be classified into (1) total, (2) subtotal, and (3) supertotal exenteration. Retrospectively study, we reviewed 7 patients that had received exenteration/subtotal exenteration with spontaneous granulation/myocutaneous flap implantation or eyelid-sparing exenteration with myocutaneous flap. Primary lesions, histopathological examination results, treatments, and recurrences are discussed. METHODS: A retrospective study of the years 1987 through 2000 disclosed 7 patients that underwent exenteration/subtotal exenteration. The patients ranged in age from 41 to 68 years. Two patients underwent total exenteration without socket augmentation; 4 patients underwent exenteration/ subtotal exenteration with immediate facial reconstruction, and 1 with delayed facial reconstruction. RESULTS: Classification of the 7 patients showed that 2 had basal cell carcinoma of the skin, 2 had squamous cell carcinoma of the conjunctiva, 1 had squamous cell carcinoma of the paranasal sinus, 1 had rhabdomyosarcoma of the paranasal sinus, and 1 had intracranial meningioma. Radiotherapy was performed in 6 of the patients and chemotherapy in 2. Central nerve system invasion was noted in 2 patients, and 1 died due to it. CONCLUSION: Secondary orbital tumors involved the orbit from adjacent tissues: paranasal sinuses, nasopharynx, lacrimal sac, conjunctiva, eyelid, intraocular tissue, and intracranial tissues. Combined surgeries are necessary for complete tumor removal. And the imaging studies should include the field of the orbit, sinus, and brain to search for the primary lesions.

Retinal capillary hemangiomas: clinical manifestations and visual prognosis.

BACKGROUND: To describe the clinical features, visual outcomes, and therapeutic complications of patients with retinal capillary hemangiomas. METHODS: A retrospective, non-comparative, observational case study of patients diagnosed with retinal capillary hemangiomas was conducted. Twelve patients (13 eyes) at Chang Gung Memorial Hospital of Kaohsiung from July 1987 to June 2001 were reviewed. Pre- and post-treatment visual acuity and ocular complications are described. RESULTS: One patient had bilateral and another had unilateral juxtapapillary hemangiomas. All of the other 10 patients were diagnosed with peripheral retinal capillary hemangiomas. More patients had retinal capillary hemangiomas located in the temporal peripheral retina and all had endophytic growth patterns. No patient met the diagnostic criteria of von Hippel-Lindau disease. Visual acuity levels of peripheral retinal hemangiomas without exudative retinal detachment often remained the same after focal laser treatment. Two patients received vitreoretinal surgery. Patients with juxtapapillary hemangiomas had variable visual outcomes and visual field defects during follow-up. CONCLUSION: Early diagnosis of capillary hemangiomas in the retinal periphery and treatment by focal laser produced good visual outcomes. If untreated, the tumors may eventually be complicated with exudative retinal detachment and have a worse visual prognosis even with vitreoretinal surgery.