Purpose: To evaluate surgical outcome and effectiveness of inferior oblique (IO) myectomy on unilateral superior oblique palsy (SOP) as a primary treatment. Methods: This study is a retrospective review of the medical records of 99 patients who had undergone IO myectomy due to SOP as a first-line treatment. Sixty-five patients with hyperdeviation of 15 prism diopters (PD) or less were categorized into group 1, 22 patients with hyperdeviation between 16 PD to 20 PD into group 2, and 12 patients with hyperdeviation higher than 20 PD into group 3. Preoperative hyperdeviation, postoperative hyperdeviation, and improvement of head tilting were then compared between the 3 groups. Surgery was determined to be successful when the post-op residual hyperdeviation is less than 5 PD, or when the improvement of hyperdeviation and head tilting was noted, for the patients who had preoperative deviation less than 5 PD, and without hypercorrection. Results: All groups showed significant improvement of hyperdeviation, and the amount of correction was larger in group with larger preoperative hyperdeviation. 80.3%, 95.0%, and 90.9% of patients showed improvement of head tiling and success rate was 87.7%, 77.3%, and 50.0% in group 1, 2, and 3 respectively. Group 1 and 2, group 2 and 3 had no significant difference in success rate but only group 1 and 3 had significant difference. Conclusions Considering success rate with improvement of head position, self-titrating and possibility of overcorrection, IO myectomy could be an effective option as a first-line surgical treatment for unilateral SOP with hyperdeviation of 20 PD or less. However, due to a 50% success rate in patients with hyperdeviation larger than 20 PD, a secondary operation must be considered following IO myectomy, or a two-muscle procedure must be considered as a primary treatment.

PURPOSE: To evaluate the change of accommodation-convergence parameters after implantation of Artisan phakic intraocular lens (PIOL). METHODS: Prospective study for the patients with the Artisan PIOL implantation was performed. A total of 37 patients (3 males and 34 females) enrolled the study. Preoperatively, convergence amplitude, the stimulus accommodative convergence per unit of accommodation (AC/A) ratio and the near point of convergence (NPC) were evaluated. After the Artisan PIOL implantation, the identical evaluations were repeated at 1 week, 1, 3, and 6 months after the surgery. RESULTS: Mean age was 24.3 +/- 4.8 years old, and preoperative refractive error was -8.92 +/- 4.13 diopters (D). After the implantation, mean refractive errors significantly decreased to within +/-1.00 D, and noticeable complications were not found. The convergence amplitude and the stimulus AC/A ratio increased 1 month after the surgery, but progressively stabilized afterward to near preoperative values. NPC didn't show any significant change over follow-up period up to 6 months. CONCLUSIONS: These results regarding implantation of the Artisan PIOL revealed the increase of accommodation-convergence relationship within first 1 month after the surgery, but progressive stabilization was noted during follow-up periods.
*Accommodation, Ocular ; Adult ; *Convergence, Ocular ; Female ; Follow-Up Studies ; Humans ; Lens Implantation, Intraocular/*methods ; Male ; Myopia/*diagnosis/*surgery ; *Phakic Intraocular Lenses ; Postoperative Period ; Prospective Studies ; Refractive Surgical Procedures/methods ; Treatment Outcome ; Visual Acuity ; Young Adult

We report a case of post-streptococcal uveitis mainly presenting with bilateral recurrent retinal vasculitis in Korea. A 14-year-old Asian female presented with decreased visual acuity of 20 / 30 in the right eye and 20 / 25 in the left eye. The patient had a history of glomerulonephritis nine months before onset of uveitis. The manifestation of uveitis was predominantly retinal vasculitis. We presumed post-streptococcal uveitis because probable streptococcal infection was confirmed by anti-streptolysin O titer elevation. With topical and oral steroid treatments, the patient experienced complete vision recovery. Post-streptococcal uveitis occurs rarely and mostly involves young patients in the form of non-granulomatous anterior uveitis. However, as this case shows, it may primarily involve the posterior uvea without anterior inflammation and may recur.
Adolescent ; Diagnosis, Differential ; Female ; Humans ; Recurrence ; Retinal Vasculitis/drug therapy/*microbiology ; Steroids/therapeutic use ; Streptococcal Infections/*diagnosis ; Uveitis/drug therapy/*microbiology ; Visual Acuity

Pediatric optic neuritis is a demyelinating optic nerve inflammation in children, characterized by acute vision loss and visual field defects, often accompanied by eye movement pain, color vision abnormalities, and relative afferent pupillary defects. It can manifest as an isolated episode or as part of broader demyelinating disorders such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease. Its incidence varies globally, with recent studies defining it as optic neuritis in individuals aged <16 years.Current Concepts: Pediatric optic neuritis has distinct clinical features compared to its adult counterpart, particularly in presentation patterns and associated systemic diseases. Children often experience greater visual acuity deficits and are more likely to develop bilateral eye involvement, severe optic disc swelling, and accompanying encephalopathic features than adults. Epidemiological studies have shown that it is relatively rare, with varying incidence rates across different regions. Diagnostic criteria are primarily based on clinical assessment, magnetic resonance imaging findings, and serological tests, including antibodies against specific biomarkers such as anti-MOG and anti-aquaporin-4 antibodies. Treatment strategies for pediatric optic neuritis involve high-dose corticosteroids followed by tapering and, in severe cases, plasma exchange or intravenous immunoglobulins. Long-term management may require immunosuppressants or biological agents, particularly in cases progressing to MS or NMOSD.Discussion and Conclusion: Understanding the unique aspects of pediatric optic neuritis is crucial for appropriate management and improving outcomes. Further studies are needed to refine diagnostic and therapeutic approaches for this condition.

Pediatric optic neuritis is a demyelinating optic nerve inflammation in children, characterized by acute vision loss and visual field defects, often accompanied by eye movement pain, color vision abnormalities, and relative afferent pupillary defects. It can manifest as an isolated episode or as part of broader demyelinating disorders such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease. Its incidence varies globally, with recent studies defining it as optic neuritis in individuals aged <16 years.Current Concepts: Pediatric optic neuritis has distinct clinical features compared to its adult counterpart, particularly in presentation patterns and associated systemic diseases. Children often experience greater visual acuity deficits and are more likely to develop bilateral eye involvement, severe optic disc swelling, and accompanying encephalopathic features than adults. Epidemiological studies have shown that it is relatively rare, with varying incidence rates across different regions. Diagnostic criteria are primarily based on clinical assessment, magnetic resonance imaging findings, and serological tests, including antibodies against specific biomarkers such as anti-MOG and anti-aquaporin-4 antibodies. Treatment strategies for pediatric optic neuritis involve high-dose corticosteroids followed by tapering and, in severe cases, plasma exchange or intravenous immunoglobulins. Long-term management may require immunosuppressants or biological agents, particularly in cases progressing to MS or NMOSD.Discussion and Conclusion: Understanding the unique aspects of pediatric optic neuritis is crucial for appropriate management and improving outcomes. Further studies are needed to refine diagnostic and therapeutic approaches for this condition.

Pediatric optic neuritis is a demyelinating optic nerve inflammation in children, characterized by acute vision loss and visual field defects, often accompanied by eye movement pain, color vision abnormalities, and relative afferent pupillary defects. It can manifest as an isolated episode or as part of broader demyelinating disorders such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease. Its incidence varies globally, with recent studies defining it as optic neuritis in individuals aged <16 years.Current Concepts: Pediatric optic neuritis has distinct clinical features compared to its adult counterpart, particularly in presentation patterns and associated systemic diseases. Children often experience greater visual acuity deficits and are more likely to develop bilateral eye involvement, severe optic disc swelling, and accompanying encephalopathic features than adults. Epidemiological studies have shown that it is relatively rare, with varying incidence rates across different regions. Diagnostic criteria are primarily based on clinical assessment, magnetic resonance imaging findings, and serological tests, including antibodies against specific biomarkers such as anti-MOG and anti-aquaporin-4 antibodies. Treatment strategies for pediatric optic neuritis involve high-dose corticosteroids followed by tapering and, in severe cases, plasma exchange or intravenous immunoglobulins. Long-term management may require immunosuppressants or biological agents, particularly in cases progressing to MS or NMOSD.Discussion and Conclusion: Understanding the unique aspects of pediatric optic neuritis is crucial for appropriate management and improving outcomes. Further studies are needed to refine diagnostic and therapeutic approaches for this condition.

Pediatric optic neuritis is a demyelinating optic nerve inflammation in children, characterized by acute vision loss and visual field defects, often accompanied by eye movement pain, color vision abnormalities, and relative afferent pupillary defects. It can manifest as an isolated episode or as part of broader demyelinating disorders such as multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease. Its incidence varies globally, with recent studies defining it as optic neuritis in individuals aged <16 years.Current Concepts: Pediatric optic neuritis has distinct clinical features compared to its adult counterpart, particularly in presentation patterns and associated systemic diseases. Children often experience greater visual acuity deficits and are more likely to develop bilateral eye involvement, severe optic disc swelling, and accompanying encephalopathic features than adults. Epidemiological studies have shown that it is relatively rare, with varying incidence rates across different regions. Diagnostic criteria are primarily based on clinical assessment, magnetic resonance imaging findings, and serological tests, including antibodies against specific biomarkers such as anti-MOG and anti-aquaporin-4 antibodies. Treatment strategies for pediatric optic neuritis involve high-dose corticosteroids followed by tapering and, in severe cases, plasma exchange or intravenous immunoglobulins. Long-term management may require immunosuppressants or biological agents, particularly in cases progressing to MS or NMOSD.Discussion and Conclusion: Understanding the unique aspects of pediatric optic neuritis is crucial for appropriate management and improving outcomes. Further studies are needed to refine diagnostic and therapeutic approaches for this condition.

PURPOSE: To investigate horizontal image disparity in three-dimensional (3-D) perception using 3-D animations in normal control patients and patients with intermittent exotropia, anisometropic amblyopia, and partially accommodative esotropia. MATERIALS AND METHODS: A total of 133 subjects were included. Stereopsis was measured using the Titmus Stereo test (Stereo Optical Inc., Chicago, IL, USA) and a 3-D stereopsis test with a 15 inch 3-D display laptop, adjusting 3-D parameters of 0 mm horizontal disparity to 15 mm horizontal disparity. RESULTS: When compared with normal controls, the average threshold of the 3-D stereopsis test was significantly reduced for esotropia patients (p<0.001) and for anisometric amblyopia patients (p<0.001), compared to normal controls. No significant difference was observed between normal controls and intermittent exotropia patients (p=0.082). The 3-D stereopsis test was correlated with the Titmus Stereo test (Spearman's rho=0.690, p<0.001). Mean difference in stereoacuity was 1.323 log seconds of arc (95% limits of agreement: 0.486 to 2.112), and 125 (92.5%) patients were within the limits of agreement. CONCLUSION: This study demonstrated that a 3-D stereopsis test with animation is highly correlated with the Titmus Stereo test; nevertheless, 3-D stereopsis with animations generates more image disparities than the conventional Titmus Stereo test. The 3-D stereopsis test is highly predictive for estimating real stereopsis in a 3-D movie theater.
Adult ; Aged ; Amblyopia/diagnosis ; Anisometropia/diagnosis ; *Depth Perception ; Esotropia/diagnosis ; Female ; Humans ; Imaging, Three-Dimensional/*instrumentation ; Male ; Middle Aged ; *Perceptual Disorders ; Software ; *Vision Disparity ; Vision, Binocular ; Visual Acuity/*physiology

PURPOSE: Isolated inferior oblique weakening procedure is an effective treatment for patients with superior oblique muscle palsy who had up to 15 prism diopters (PD) of vertical deviation in the primary position, but 2-muscle surgery is needed for patients with larger deviations. Herein, we report the surgical results of simultaneous 2-extraocular muscle surgery for large primary position hypertropia 16 PD or more caused by superior oblique palsy. METHODS: This study was a retrospective review of the records of patients who presented with central gaze hypertropia 16 PD or more and underwent simultaneous 2-extraocular muscle surgery between January 2003 and June 2014 in Severance Hospital. The patients were divided into 3 groups: 43 patients who underwent inferior oblique (IO) myectomy and contralateral inferior rectus (IR) recession (Group 1), 10 patients who underwent IO myectomy and superior rectus (SR) recession (Group 2), and 8 patients who underwent SR recession and contralateral IR recession (Group 3). Criteria for success included correction of head posture and a primary position alignment within 5 PD of vertical deviation. RESULTS: Mean preoperative alignment at primary gaze was 25.5 ± 7.1 PD (range, 16-60 PD) compared to the postoperative value of -1.3 ± 6.8 PD (range, -20~25 PD) (p < 0.001). Surgery was successful in 49 (80%) patients. Nine (15%) patients were overcorrected and the other 3 (5%) patients were undercorrected. Success rate was the highest in subjects who underwent IO myectomy and contralateral IR recession. Among the 24 patients who did not receive combined horizontal muscle surgery, horizontal deviations decreased from 10.4 ± 2.7 PD to 1.5 ± 5.5 PD (p < 0.001) CONCLUSIONS: Two-muscle surgery can be effective in patients with large hypertropia 16 PD or more. Additionally, horizontal deviations are more likely to be resolved with vertical muscle surgery alone. However, IO myectomy combined with ipsilateral SR recession can cause overcorrection postoperatively, so surgical dose should be reduced when performing weakening procedure of two elevators in one eye.
Elevators and Escalators ; Head ; Humans ; Jupiter ; Paralysis* ; Posture ; Retrospective Studies ; Strabismus*

Purpose: To compare refractive error measured by hand-held wavefront aberrometers with postcycloplegic autorefraction (AR) and cycloplegic refraction (CR). Methods: The medical records of patients who received refractive measurements using the wavefront aberrometer, postcycloplegic AR, and CR between January 2014 and January 2016 were retrospectively analyzed. The mean differences, 95% confidence intervals, and limits of agreement (LOA) were calculated for the refractive vector components (M, J0, and J45). Results: Fifty-one patients (9.0 ± 5.5 years, male 41.2%) were enrolled in this study, and only the right eye of each was included. Refractive errors ranged from -9.25 to +7.25 diopters (D) for spherical equivalent (median, 0.75 D). The M component was not significantly different among the three methods (p = 0.080). However, the J0 vector component was significantly different (p < 0.001). After post hoc analysis, the wavefront aberrometer obtained more positive values for J0 compared to the other methods. The J45 component was not significantly different among the three methods (p = 0.143). The mean difference between the wavefront aberrometer and postcycloplegic AR was -0.115 D (LOA, -1.578 to 1.348 D) for M, 0.239 D (LOA, -0.371 to 0.850 D) for J0, and -0.015 D (LOA, -0.768 to 0.738 D) for J45. The mean difference between the wavefront aberrometer and CR was -0.220 D (LOA, -1.790 to 1.350 D) for M, 0.300 D (LOA, -0.526 to 1.127 D) for J0, and -0.079 D (-0.662 to 0.504 D) for J45. Conclusions The wavefront aberrometer showed good agreement with postcycloplegic AR and CR in spherical equivalents, but tended to produce slightly myopic results. The wavefront aberrometer also overestimated with-the-rule astigmatism. Therefore, we recommend that the device be used for estimations of refractive error, which may be useful for patients who have postural difficulties, live in undeveloped countries, or are bedridden.