The Influence of Part-time Patching Therapy on Types of Intermittent Exotropia

PURPOSE: To evaluate the influence of part-time patching therapy on the types of intermittent exotropia. METHODS: Forty-four children with basic type intermittent exotropia and 26 with convergence insufficiency type, aged 4 to 12 years, were evaluated. At initial examination, the deviating angles were obtained at distant and near with the alternate prism cover test after correcting for refractive errors. The types of intermittent exotropia were classified based on the reference values of distant-near difference as follow. In the patients with distant angle more than 30 PD, the reference value of distant-near difference was 10 PD, whereas in the patients with distance angle less than 30 PD, the value was one third of the distant angle. Three-hour per day patching of the non-deviating eye was performed for 3 months, and the change in the types of intermittent exotropia was investigated. RESULTS: At initial examination, mean deviating angles (PD) were 27.1 +/- 7.46 PD at distant, and 30.6 +/- 7.92 PD at near. After 3 months with 3-hours patching, the deviating angles were both reduced significantly to 25.9 +/- 9.10 PD at distant and 21.4 +/- 11.00 PD at near (p=0.005, <0.001 respectively). Fourteen patients (32%) of basic type were transformed to pseudodivergence excess type. Among the patients with basic type who showed no change in type, 9 (20%) showed a reduction of angles at both near and distant. Among the patients with convergence insufficiency type, 18 (69%) were converted to basic type and 2 (7%) to pseudodivergence excess type. CONCLUSIONS: Three-hour patching therapy converted the basic and convergence insufficiency type to the pseudodivergence excess and basic type in more than half of the intermittent exotropes.

Two Cases of Rhino-Orbitocerebral Mucormycosises that Manifested as Noninflammatory Oculomotor Nerve Palsy

PURPOSE: Rhino-orbitocerebral mucormycosis is the disease that cause orbital cellulitis, orbital apex syndrome, and orbital necrosis. We report two cases of mucormycosis that began with only noninflammatory oculomotor nerve palsy. METHODS: 74-year-old man and 53-year-old woman with DM visited our hospital for sudden ptosis, mydriasis, and paralytic strabismus. MRI scan and other neurological examinations were negative except mild sinusitis. Patients were diagnosed as complete third nerve palsy. RESULTS: A few days later, they developed orbital apex syndrome with exophthalmos and abrupt reduction of visual acuity. Emergency biopsy of sinusitis was done, and revealed mucormycosis. CONCLUSIONS: Sudden oculomotor nerve palsy in chronic debilitating patients with DM and sinusitis should be suspected as prodrome of rhino-orbito-cerebral mucormycosis.

Keratocyte Loss in Anterior Stroma of the Rabbit Cornea after Photorefractive keratectomy

This study evaluated the response of the anterior stromal keratocytes in Rabbits following deepithelialization and 3 diopter(37micrometer)- and 12 diopter(99micrometer) PRK. The corneal sections obtained from the operated area on postoperative 3, 7 and 14 days were stained with hematoxylin and eosin. Keratocyte apoptosis were monitored using the terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling(TUBEL) staining with ApopTag kit for the corneal section obtained on postoperative 3 day. The corneal haze on postoperative 14 day were graded using a slit lamp biomicroscopy. The number of anterior stromal keratocytes had decreased significantly and positive TUNEL staining was noted in the anterior stroma after PRK and deepithelialization campared with that of controls. The decreased keratocyte numbers were recovered on postoperative 7 day after deepithelialization and on postoperative 14 day after PRK. The newly appeared deratocytes were pyknotic, variable-shaped and crosswisely oriented in appearance, and especially increased following 12 diopter PRK. Both the keratocyte loss and corneal haze grading was increased related to the increased ablation depth after PRK. In conclusion, the loss of anterior stromal keratocytes after PRK is mediated by apoptosis and followed by reactive cellular proliferation might be a important role in the corneal haze.

Decentration after Laser in Situ Keratomileusis(LASIK) and Photorefractive Keratectomy(PRK)

LASIK procedure was introduced recently for the correction of high myopia because of many complications in high-myopic PRK. The characteristic procedures such as hinged flap formation and stromal ablation may increase decentration. We evaluated the amount of decentration relative to the pupil center in 80 eyes of LASIK and 52 eyes of PRK using corneal topography(Corneal Analysis System: EyeSys Laboratories). All treatments were performed using excimer laser, Aesculap-Meditec, MEL 60-94 and corneal light reflex was used for centering. The vacuum ring was used for globe fixation. Mean amount of decentration in LASIK(0.65+/-0.42mm) was statisticallysignificantly increased compared with 0.49+/-0.29mm in PRK(p=0.01). Under -12D of attempted correction, mean amount of decentration in LASIK was 0.54+/-0.38mm which was not significantly different from 0.49+/-0.29mm in PRK(p=0.07). No correlation was observed between the magnitude of decentration and the frequency of loss of best cerrected visual acuity and night glare(p>0.05). The decentration more than 1mm was associated with increased amount of attempted correction (p=0.003) and low preoperative best corrected visual acuity(p=0.01). We considered that the differencee of the magnitude of decentration was attributed to some difference in procedures between LASIK and PRK. When vaccum ring is not used in other reports with other device, the decentration of LASIK was approximately twice as much as in PRK. The use of vacuum ring for the maintenance of globe may be effective in LASIK in which patients self fixation during ablation is more difficult than in PRK because the ablation time is longer and the ablation is performed on the stroma after flap formation.

Inhibition of Corneal Angiogenesis by Orally Administered Thalidomide

Thalidomide, a potent teratogen, is Known as an angiogenic inhibitor. This study was performed to examine the effect of thalidomide on corneal angiogenesis in rabbit cornea induced by chemical cauterization. We applied Whatman filter paper disc soaked in 30% silver nitrate (AgNO3) application on corneas of 12 white rabbits. After 5days, we administered oral dose of 100mm2 thalidomide to the 6 animals everyday and examined the length and extent of neovascularization to evaluate the area of neovascularization. After 2 days of oral administration, the increase of neovascularization is 14.3+/-11.7mm2in thalidomide-treated group and 27.9+/-14.6mm2 in cotrol grop. The area of neovascularization reached to its maximum at day 9 in thalidomide-treated group compared to day 11 in control group and decreased thereafter in both groups. The increase of the area of vascularized cornea revealed 28.0+/-13.5mm2 in thalidomide-treated group and 44.4+/-12.7mm2 in control group at the day 9 (p=0.04, Wilkoxon Matched-pairs signed-rank test). This fact means that treatment with thalidomide resulted in an inhibition of the area of vascularized cornea with the median inhibition of 37.3%. On light micrographs, there were infiltration of inflammatory cell and capillary lumens in corneal stroma in both animals. Electron micrographs of thalidomide-treated animals showed loss of vascular endothelial cell junction, mitochondrial swelling and loss of cristae which were not found in control animals. This results suggest that orally-administered thalidomide has a direct effect on the growing vasculature and an inhibitory effect on corneal angiogenesis.

Central Serous Chorioretinopathy in Women Compared with in Man

Idiopathc Central Serous Chorioretinopathy (ICSC)is a self-limited disorder that typically affects healthy middle-aged men. Although extensive information is available pertaining to the clincial features of ICSC in men, little is known about this condition in women. The authors reviewed the medical records and photographic files of 41 CSC cases of women, and comparison was made with 52 cases of men. Thirty eight cases of women were idiopathic, two women were pregnant in the third trimester, and one woman was taking exogenous corticosteroids for asthma. The findings in women with ICSC were similar to those in men, with exception that women tend to have lower initial visual acuity(p0.05). The average duration of illness was 3.3 months and the final visual acuity was 0.8 or better in 84.2% and worse than 0.1 in one patient who developed SRNVM. The recurrent elevation was observed in 10.5% of patients. Thus ICSC in women is similar to or more benign than those generally described in men.