Ethnic disparity in prevalence and associated risk factors of myopia in adolescents.

BACKGROUND/PURPOSE: To examine ethnic disparity in prevalence and associated factors of myopia in adolescents using the Unites States National Health and Nutrition Examination Survey (NHANES) dataset. METHODS: Participants who were aged 12-19 years were included from NHANES (1999-2008). Logistic regression analyses were applied to identify risk factors associated with myopia after stratification by race. RESULTS: A total of 9,960 participants were included in the prevalence analysis, and 6,571 in the risk factor analysis. Other race (excluded Mexican American, other Hispanic, non-Hispanic white, non-Hispanic black) participants had the highest frequency of myopia (42.77%). Multivariate analyses of the whole population suggested that the odds of myopia were significantly lower in participants with household smokers (odds ratio [OR] = 0.79, 95% confidence interval [CI]: 0.66-0.97), and significantly greater in Mexican American race (OR = 1.28, 95% CI: 1.01-1.62), other Hispanic (OR = 1.79, 95% CI: 1.10-2.92) and in participants with senior high school graduate education (OR = 1.79, 95% CI: 1.01-3.18), watched 2 hours of television daily (OR = 1.27, 95% CI: 1.02-1.59), used the computer for 1 hour daily (OR = 1.276, 95% CI: 1.02-1.57). When examined by race/ethnicity, 1 hour of computer use increased the odds of myopia in the non-Hispanic White group, in Mexican Americans a higher family poverty income ratio and 2 hours of television time was associated with myopia, and in the Other Hispanic group, a higher family poverty income ratio was associated with myopia, while males and those with a higher sugar had a lower risk of myopia. CONCLUSION: Risk factors for myopia vary with race/ethnicity.

Upper eyelid granuloma: a rare delayed-onset complication secondary to cosmetic filler injection on forehead.

A 72-year-old Taiwanese woman had the history of cosmetic cryopreserved autologous fat injection on her forehead ~21 years ago and was referred to our oculoplastic clinic and presented with multiple painless mass, which she had for 4 years, on both upper eyelids. Histopathology confirmed the diagnosis of foreign body granuloma on both upper eyelids. Clinicians should be aware of the potential complication of granuloma reaction and migration even many years after the injection. We advise that autologous fat injection should be performed solely by trained physicians and it should be made known that there is a possible occurrence of migration.

Relenza-Induced Acute Myopia Change.

PURPOSE: To report a case of a patient with a notable side effect to Relenza, an anti-influenza virus medication, who also developed acute transient myopia. CASE REPORT: A 31-year-old woman was diagnosed as having seasonal influenza and treated with Relenza. However, an allergic reaction and blurred vision caused by a transient myopic change were noted after she received Relenza treatment. Relenza-induced acute transient myopia had never been reported. The possible mechanisms include (1) ciliary spasm, (2) lens edema, (3) ciliary body and/or choroidal effusion. Fortunately, the drug-induced myopic change mostly resolved spontaneously after discontinuation of the drug and had a benign course. CONCLUSIONS: Patients suspected of having drug-induced myopia should be examined by an internist for a systemic allergic reaction and referred to an optometrist or an ophthalmologist for further special examinations such as A-scan, B-scan, and ultrasound biomicroscopy. Optometrists and ophthalmologists should keep in mind and be aware of the possible ocular side effect (myopic change) of Relenza and warn patients of this potential condition.

Proteomic analysis and identification of aqueous humor proteins with a pathophysiological role in diabetic retinopathy.

Diabetic retinopathy (DR) can cause irreversible blindness and is the severest microvascular complication in the eyes of patients with diabetic mellitus (DM). The identification of susceptibility factors contributing to development of DR is helpful for identifying predisposed patients and improving treatment efficacy. Although proteomics analysis is useful for identifying protein markers related to diseases, it has never been used to explore DR-associated susceptibility factors in the aqueous humor (AH). To better understand the pathophysiology of DR and to identify DR-associated risk factors, a gel-based proteomics analysis was performed to compare AH protein profiles of DM patients with and without development of DR. MALDI-TOF MS was then performed to identify protein spots that were differentially expressed between the two groups and western blot analysis was used to validate the expressional change of protein demonstrated by proteomics. Our proteomics and bioinformatics analysis identified 11 proteins differentially expressed between DR and control groups. These proteins are linked to biological networks associated with nutrition transport, microstructure reorganization, angiogenesis, anti-oxidation, and neuroprotection. The data may provide potential AH biomarkers and susceptibility factors for predicting DR development, and provide an insight into the underlying pathophysiological mechanisms of DR. This article is part of a Special Issue entitled: Proteomics: The clinical link.

Ocular responses and visual performance after emergent acceleration stress.

PURPOSE: To evaluate visual function after emergent acceleration stress. METHODS: Sixteen subjects were enrolled in this study. Human ejection seat trainer was used to induce six times gravitational force in the head-to-toe (z-axis) direction (+6 Gz). Visual performance was evaluated using the visual chart and contrast sensitivity (CS) at indicated times. Ocular reactions were assessed with biomicroscopy and topographic mapping. RESULTS: Temporary visual acuity reduction (0.02 ± 0.05 vs. 0.18 ± 0.08 logMAR visual acuity [VA]; P < 0.05) and ocular reactions were observed after ejection. These reactions included changes in increasing anterior chamber depth (ACD; 3.18 ± 0.29 vs. 4.48 ± 0.32 mm; P < 0.05) and pupillary dilation (PD; 3.56 ± 0.72 vs. 5.64 ± 0.56 mm; P < 0.05). The ACD deepening continued at 15 minutes (4.37 ± 0.26 mm; P < 0.05), and PD persisted at 30 minutes after the gravitational stress (5.42 ± 0.54 mm, P < 0.05). CS decreased significantly at all spatial frequencies immediately after ejection. However, CS returned to the initial range at high spatial frequency by 30 minutes. CONCLUSIONS: Emergent acceleration force induces significant ocular responses and visual fluctuation. Prolonged ACD deepening (>15 minutes) and PD (>30 minutes) were noted, but cornea and refraction remain stable. CS at all spatial frequencies revealed remarkable reduction immediately after ejection, and recovered to baseline levels within 30 minutes only at high spatial frequency. Neuroretinal function may involve visual fluctuation after acceleration stress, because visual fluctuation corresponds with the characters of neuroretinal function. However, further studies are necessary.

Long-term corneal retention of trichomes from bamboo shoots.

PURPOSE: To describe a rare case of corneal injury by trichomes of bamboo shoots. METHODS: A 58-year-old woman rubbed her right eye after touching a bamboo shoot, not knowing that there were many trichomes adherent to her hands. Severe conjunctival congestion and chemosis developed immediately but subsided the next day without visual impairment. Many trichomes were incidentally found to be embedded in the subepithelial region of the cornea on a routine slit-lamp examination. Three days after partial removal of the trichomes under a microscope, the epithelium had healed completely. RESULTS: Histopathologic examination showed bamboo trichomes in the epithelial scraping without inflammation. CONCLUSIONS: Trichomes of bamboo shoots may affect and stay in the cornea without significant inflammation because of their inert nature.

Purtscher's-like retinopathy as an initial presentation of adult-onset Still's disease: a case report and review of the literature.

Adult-onset Still's disease is a multisystem inflammatory disorder of unknown etiology and is characterized by high, spiking fever, arthritis, evanescent maculopapular rash, myalgia, serositis, leukocytosis, and involvement of various organs including the eyes. The ocular manifestations have been described including orbital pseudotumor, ptosis, and diplopia with orbital pain but never Purtscher's-like retinopathy. We describe a 21-year-old male patient with adult-onset Still's disease who developed the Purtscher's-like retinopathy. To our knowledge, this is the first reported adult-onset Still's disease patient with Purtscher's-like retinopathy as the initial presentation.

Clinical outcomes of combined sutureless vitrectomy with triamcinolone stain to manage vitreous loss resulting from posterior capsule rupture during phacoemulsification.

PURPOSE: To investigate the efficacy of sutureless pars plana vitrectomy (PPV) combined with intracameral triamcinolone stain in the management of vitreous loss associated with phacoemulsification. SETTING: Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China. METHODS: This retrospective review comprised the charts of 21 patients who had sutureless PPV combined with intracameral triamcinolone stain to manage vitreous loss resulting from posterior capsule rupture during phacoemulsification. The charts were analyzed for type of cataract, posterior segment pathology, methods of anesthesia, intraocular lens (IOL) placement, postoperative visual acuity, intraocular pressure, and complications. Additional outcome measurements were duration of the surgical procedures, period of postoperative corneal edema, and time to achieve stable vision. RESULTS: Excluding 2 eyes with preexisting conditions, 18 of 19 eyes (94.7%) had a final best corrected visual acuity (BCVA) of 20/40 or better and 42.1% (8/19) had a final BCVA of 20/20 or better. The mean duration of the surgery was 25.3 minutes (range 16 to 40 minutes). Corneal edema was noted in 12 eyes (57.1%) 3 days postoperatively and 3 eyes (14.3%) at 7 days. Eleven eyes (52.4%) had stable vision at 1 week, and 16 eyes (76.2%) had stable vision within 1 month postoperatively. Four eyes (19.0%) had postoperative complications that included a displaced IOL in 3 eyes (14.3%) and cystoid macular edema in 1 eye (4.8%). CONCLUSIONS: Self-sealing, sutureless PPV combined with intracameral triamcinolone stain was a safe, reliable adjunct to manage vitreous loss during phacoemulsification. The surgery led to rapid visual recovery.

Comparison of clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy and standard 20-gauge vitrectomy for patients with cataract and vitreoretinal diseases.

PURPOSE: To compare effectiveness and outcomes of clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy and standard 20-gauge vitrectomy system for patients with clinically significant cataract and vitreoretinal diseases. SETTING: Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China. METHODS: Clear corneal phacoemulsification combined with 25-gauge transconjunctival sutureless vitrectomy was performed in the study group (15 eyes). Patients in the control group (15 eyes) had combined surgery with clear corneal phacoemulsification and the existing 20-gauge vitrectomy system, providing a comparison between 2 groups with regard to preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure, and intraoperative and postoperative complications. The additional outcome measurements in both groups were duration of the surgical procedures, time to return to preoperative corneal clarity, time to achieve stable vision, and subjective ocular irritation postoperatively. RESULTS: Postoperatively, BCVA improved in 12 eyes (80%) in the study group and in 11 eyes (73.3%) in the control group. Mean operative time for opening and closing the sclerotomy was significantly greater in the control group than in the study group. Time to return to preoperative corneal clarity and time to achieve stable vision showed no significant difference between the groups. Compared with the control group, postoperative ocular irritation in patients in the study group was considerably reduced. CONCLUSIONS: Combined sutureless surgery needed shorter setup time for sclerotomy and caused less postoperative ocular irritation than combined surgery with 20-gauge vitrectomy. Therefore, this type of procedure would be a good option for selected cases with cataract and vitreoretinal diseases.

Calcified cataractous lens.

We report a calcified cataractous lens in a 24-year-old man who had retinal degeneration in the right eye since childhood. The visual acuity had dropped to light perception. Clear corneal phacoemulsification was performed, and the shell of a 5.4 mm x 4.0 mm x 2.0 mm calcified substance was removed with a forceps using the can-opener technique. The specimen was analyzed using radiological study, histopathological examination, chemical element analysis, and transmission electron microscopy. Four years postoperatively, the patient's visual acuity was 20/200.