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Anomalous Scleral Insertion of Superior Oblique in Axenfeld-Rieger Syndrome.

Sang Woo PARK ; Hwang Gyun KIM ; Hwan HEO ; Yeoung Geol PARK

Korean Journal of Ophthalmology.2009;23(1):62-64. doi:10.3341/kjo.2009.23.1.62

Axenfeld-Rieger syndrome (ARS) is associated with ocular and systemic anomalies. PITX2 is known to be a major controlling gene in the pathogenesis of ARS and is associated with differentiation in both the neural crest and mesoderm during eye development. A 4-year-old girl with bilateral ARS had 20 prism diopters (PD) of exotropia with 30PD of A- pattern deviation, more than 20PD of dissociated vertical deviation (DVD), and severe superior oblique overaction (SOOA). During surgery we observed that the SO inserted more posteriorly than normal. We believe this finding is one of the abnormal manifestations of the development of the extraocular muscles in ARS.
*Abnormalities, Multiple ; Anterior Eye Segment/*abnormalities ; Child, Preschool ; Eye Abnormalities/*diagnosis/surgery ; Eye Movements ; Female ; Follow-Up Studies ; Humans ; Oculomotor Muscles/*abnormalities/surgery ; Ophthalmologic Surgical Procedures/*adverse effects ; Optic Nerve/abnormalities ; Postoperative Complications ; Sclera/*pathology/surgery ; Syndrome ; Tooth Abnormalities/*genetics

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The Effect of an Intravitreal Triamcinolone Acetonide Injection for Acute Nonarteritic Anterior Ischemic Optic Neuropathy.

Byung Jae SOHN ; Bo Young CHUN ; Jung Yoon KWON

Korean Journal of Ophthalmology.2009;23(1):59-61. doi:10.3341/kjo.2009.23.1.59

The purpose of this case report is to evaluate the visual outcome of an intravitreal triamcinolone acetonide injection (IVTA) as a treatment for a patient with acute nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old male patient with severe visual loss due to acute NAION was treated with 4 mg/0.1mL IVTA. Fundus examination and measurements of the patient's best-corrected visual acuity and visual field were performed before and after the injection at 2 weeks, 1 month, 3 months, and 6 months. The best-corrected visual acuity changed from 0.05 before the injection to 0.16 at 2 weeks, 0.3 at 1 month, and 0.4 at 3 months and at the final visit. Optic disc swelling had markedly decreased at 1 week postoperatively and disappeared at 2 weeks after the injection. The clinical course of this patient suggests that an IVTA may be effective in increasing visual acuity following an acute NAION. A large randomized controlled trial is needed to assess the efficacy of IVTA as a treatment for NAION.
Acute Disease ; Aged ; Diagnosis, Differential ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Glucocorticoids/*administration & dosage ; Humans ; Injections ; Male ; Ophthalmic Solutions ; Optic Neuropathy, Ischemic/*drug therapy/pathology/physiopathology ; Triamcinolone Acetonide/*administration & dosage ; Visual Acuity ; Visual Fields ; Vitreous Body

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A Case of Carotid Aneurysm in Familial Retinal Arterial Tortuosity.

Je Hyun SEO ; Ivana KIM ; Hyeong Gon YU

Korean Journal of Ophthalmology.2009;23(1):57-58. doi:10.3341/kjo.2009.23.1.57

A 44-year-old woman who showed recurrent vitreous hemorrhages with vascular tortuosity received CT angiography which revealed an internal carotid artery aneurysm. A case of internal carotid aneurysm was associated with a pattern of retinal arteriolar tortuosity pathognomic for familial retinal arterial tortuosity (fRAT), suggesting possible involvement of the cerebral circulation. We present a case of internal carotid aneurysm associated with a pattern of retinal arteriolar tortuosity pathognomic for fRAT.
Adult ; Aneurysm/*complications/radiography ; Angiography ; Carotid Artery Diseases/*complications/radiography ; *Carotid Artery, Internal ; Diagnosis, Differential ; Eye Abnormalities/complications/diagnosis/*genetics ; Female ; Follow-Up Studies ; Humans ; Retinal Artery/*abnormalities ; Tomography, X-Ray Computed ; Torsion Abnormality/complications/diagnosis/*genetics ; Visual Acuity

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Two Cases of Branch Retinal Arterial Occlusion After Carotid Artery Stenting in the Carotid Stenosis.

Sang Joon LEE ; Soo Young KIM ; Shin Dong KIM

Korean Journal of Ophthalmology.2009;23(1):53-56. doi:10.3341/kjo.2009.23.1.53

We describe two cases of branch retinal artery occlusion (BRAO) after carotid artery (CA) stenting. Case 1: A 57-year-old man diagnosed with left neovascular glaucoma was admitted to our department for trabeculectomy (He had complained of decreased visual acuity (VA) in the left eye for a month). A preoperative neck angio CT scan showed bilateral CA stenosis. After CA stenting, he contracted visual defects on the right superior area of his right eye. Upon examination, VA with correction was found to be 1.0 (OD), but right fundoscopy revealed ischemic retina whitening along the inferior temporal arcade. Case 2: A 64-year-old man received left CA stenting for severe stenosis in the Department of Neurology. The next day, he was referred to us for acute onset of a left naso-inferior visual field defect. Upon initial examination, his VA with correction was 0.8/0.16 (OD/OS) and fundoscopy revealed ischemic retina whitening at the superior posterior pole in the left eye. It was not necessary to treat the BRAO in these cases because the foveal capillary network was not invaded at 2 month follow ups, VA was preserved in both cases. In conclusion, ophthalmic evaluation is important after CA stenting because of a possible embolic occlusion of the retinal artery.
Angiography ; Carotid Stenosis/radiography/*surgery ; Fibrinolytic Agents/therapeutic use ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Male ; Middle Aged ; Retinal Artery Occlusion/diagnosis/drug therapy/*etiology ; Stents/*adverse effects ; Visual Acuity ; Visual Fields

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A Choroidal Schwannoma Confirmed by Surgical Excision.

Young Jae CHO ; Jung Bin WON ; Suk Ho BYEON ; Woo Ik YANG ; Hyoung Jun KOH ; Oh Woong KWON ; Sung Chul LEE

Korean Journal of Ophthalmology.2009;23(1):49-52. doi:10.3341/kjo.2009.23.1.49

Schwannomas rarely present as intraocular tumors and are often misdiagnosed as malignant melanoma. We describe a choroidal schwannoma confirmed by sclerouvectomy. A 30-year-old woman presented with a large nonpigmented intraocular mass of the choroid in the right eye and underwent surgical excision by sclerouvectomy. Histologically, the tumor was composed of a mixture of cellular solid components (Antoni A) and loose myxoid components (Antoni B). The tumor was eventually diagnosed as a schwannoma. Currently available ancillary studies are still of little value in definitively differentiating schwannomas from other choroidal tumors. In the case of atypical findings for a malignant melanoma, a benign neoplasm should be included in the differential diagnosis. This patient avoided enucleation by first having the mass excised. We are unaware of previous reports in which a choroidal schwannoma was diagnosed by surgical excision.
Adult ; Choroid/*pathology ; Choroid Neoplasms/*diagnosis/surgery ; Diagnosis, Differential ; Eye Enucleation/*methods ; Female ; Humans ; Magnetic Resonance Imaging ; Neurilemmoma/*diagnosis/surgery

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Topical and Oral Voriconazole in the Treatment of Fungal Keratitis.

Sang Joon LEE ; Jung Joo LEE ; Shin Dong KIM

Korean Journal of Ophthalmology.2009;23(1):46-48. doi:10.3341/kjo.2009.23.1.46

We describe two patients with fungal keratitis refractory to standard antifungal therapy whose conditions were managed with voriconazole. The first case is a patient with endophthalmitis and corneal ulcer due to Candida parapsilosis after receiving a corneal transplant. The patient was treated with amphotericin but showed no signs of improvement. Topical voriconazole, oral voriconazole, and intravitreal voriconazole yielded signs of improvement. The second case is a 63-year-old male who underwent a month of empiric treatment with 0.2% topical amphotericin for fungal keratitis but showed no signs of improvement. Treatment was then provided with 1% voriconazole. Both cases showed effective treatment with voriconazole. Voriconazole may be considered as a new method to treat fungal keratitis refractory to standard antifungal therapy.
Administration, Oral ; Antifungal Agents/*administration & dosage ; Candidiasis/diagnosis/*drug therapy/microbiology ; Cornea/microbiology/pathology ; Diagnosis, Differential ; Dose-Response Relationship, Drug ; Eye Infections, Fungal/diagnosis/*drug therapy/microbiology ; Follow-Up Studies ; Humans ; Keratitis/diagnosis/*drug therapy/microbiology ; Male ; Middle Aged ; Ophthalmic Solutions ; Pyrimidines/*administration & dosage ; Triazoles/*administration & dosage

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Granular Cell Tumor of The Inferior Rectus Muscle.

Ceren Erdogan POYRAZ ; Hayyam KIRATLI ; Figen SOYLEMEZOGLU

Korean Journal of Ophthalmology.2009;23(1):43-45. doi:10.3341/kjo.2009.23.1.43

A 53-year-old woman complaining of vertical diplopia, presented with a localized swelling in the right lower lid. Magnetic resonance imaging studies demonstrated a relatively well-defined mass in the inferior rectus with similar signal characteristics to the muscle. Excisional biopsy of the mass revealed granular cell tumor composed of S-100 positive cells with acidophilic granular cytoplasm and a peripheral lymphocytic infiltration. Granular cell tumor, which is very rare in the orbit, should be considered in the differential diagnosis of tumors adjacent to or within the extraocular muscles, particularly in the inferior orbit.
Biopsy ; Diagnosis, Differential ; Eye Neoplasms/*pathology ; Female ; Follow-Up Studies ; Granular Cell Tumor/*pathology ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Muscle Neoplasms/*pathology ; Oculomotor Muscles/*pathology

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The Comparison of Mydriatic Effect Between Two Drugs of Different Mechanism.

Ji Hyun PARK ; Young Chun LEE ; Se Youp LEE

Korean Journal of Ophthalmology.2009;23(1):40-42. doi:10.3341/kjo.2009.23.1.40

PURPOSE: To maximize effective use of mydriatic drugs through comparing the pupillary dilation effects between 1% tropicamide and 2.5% phenylephrine. METHODS: Fifty people requiring pupillary dilation were divided into 3 groups. Group 1 was treated with one drop of 1% tropicamide in the right eye and one drop of 2.5% phenylephrine in the left eye. Group 2 was treated twice during a 5-minute interval with 1% tropicamide in the right eye. Group 3 was treated twice during a 5-minute interval with 2.5% phenylephrine in the right eye. Groups 2 and 3 were treated with 2.5% phenylephrine and 1% tropicamide in the left eye, administered during a 5-minute interval. The pupillary size was measured in all groups for 40 minutes following eye drops administration. RESULTS: The mean patient age was 15.7 years. Group 1 included 10 patients, and groups 2 and 3 included 20 patients each. Eight patients in group 1 and 16 patients in group 2 developed a larger right pupil. Fourteen patients in group 3 developed a larger left pupil. CONCLUSIONS: Our study showed that 1% tropicamide, with its parasympathetic antagonistic mechanism of action, was more effective at inducing pupillary dilation than 2.5% phenylephrine, and the combination of 1% tropicamide and 2.5% phenylephrine was more effective than multiple drops of single eye drops.
Adolescent ; Adult ; Child ; Child, Preschool ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Humans ; Male ; Muscarinic Antagonists/*administration & dosage ; Mydriatics/*administration & dosage ; Ophthalmic Solutions ; Phenylephrine/*administration & dosage ; Pupil/*drug effects ; Refractive Errors/diagnosis/physiopathology ; Retrospective Studies ; Tropicamide/*administration & dosage ; Young Adult

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Twenty-Four Hour Blood Pressure Pattern in Patients With Normal Tension Glaucoma in the Habitual Position.

Soo Geun JOE ; Jaewan CHOI ; Kyung Rim SUNG ; Seong Bae PARK ; Michael S KOOK

Korean Journal of Ophthalmology.2009;23(1):32-39. doi:10.3341/kjo.2009.23.1.32

PURPOSE: To investigate the relationship between blood pressure (BP) parameters in the habitual position and glaucomatous damage at initial presentation in patients with untreated normal tension glaucoma (NTG). METHODS: Fifty-four eyes from 54 subjects diagnosed with NTG were consecutively enrolled. BP was measured with an automated ambulatory monitoring device in the habitual position during 24-hour in-hospitalization. Patients were classified into three groups: non-dippers, dippers, and over-dippers. corresponded to the degree of reduction in their nocturnal mean arterial pressure (MAP) compared with their diurnal MAP. Regression models were used to evaluate potential risk factors, including: age, pre-admission office intraocular pressure (IOP), central corneal thickness (CCT), and BP parameters. Functional outcome variables for glaucomatous damage included mean deviation (MD) and pattern standard deviation (PSD) on a Humphrey field analyzer (HFA). Anatomic outcome variables were TSNIT score (temporal, superior, nasal, inferior, and temporal) average, superior average, inferior average, and nerve fiber indicator (NFI) score on scanning laser polarimetry with variable corneal compensation (SLP-VCC; GDx-VCC). RESULTS: Marked systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP fluctuation were noted in the over-dipper group (p<0.05). A linear regression analysis model revealed that nocturnal trough DBP and MAP, average nocturnal SBP, and MAP were all significantly associated with a decreased average TSNIT score and an increased NFI score. CONCLUSIONS: Nocturnal BP reduction estimated in the habitual position was associated with structural damage in eyes with NTG. This finding may suggest systemic vascular etiology of NTG development associated with nocturnal BP reduction.
Adult ; Aged ; Aged, 80 and over ; Blood Pressure/*physiology ; Blood Pressure Monitoring, Ambulatory/*methods ; Circadian Rhythm/*physiology ; Disease Progression ; Female ; Follow-Up Studies ; Glaucoma, Open-Angle/diagnosis/*physiopathology ; Humans ; Intraocular Pressure/physiology ; Male ; Middle Aged ; Nerve Fibers/pathology ; Posture/*physiology ; Prognosis ; Prospective Studies ; Retina/pathology ; Risk Factors ; Visual Fields

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Comparison Between Dynamic Contour Tonometry and Goldmann Applanation Tonometry.

Jooeun LEE ; Chang Hwan LEE ; Jaewan CHOI ; Sam Young YOON ; Kyung Rim SUNG ; Seong Bae PARK ; Michael S KOOK

Korean Journal of Ophthalmology.2009;23(1):27-31. doi:10.3341/kjo.2009.23.1.27

PURPOSE: To compare the intraocular pressures (IOPs) measured by dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT), and to investigate the association of IOPs on eyes of varying central corneal thickness (CCT). METHODS: In this prospective study, 451 eyes of 233 subjects were enrolled. IOPs were measured by GAT and DCT. CCT was measured three times and the average was calculated. Each eye was classified into one of three groups according to CCT: low CCT (group A, CCT<520 micrometer, n=146); normal CCT (group B, 520 micrometer < or = CT < or = 550 micrometer, n=163); and high CCT (group C, CCT>550 micrometer, n=142). In each group, we investigated the association of CCT with IOP measurement by GAT and DCT. RESULTS: The IOPs measured by GAT and DCT were significantly associated for all eyes (R=0.853, p<0.001, Pearson correlation). CCT was related with both IOP measurement by GAT and DCT with statistical significance (mixed effect model, p<0.001). However, subgroup analysis showed that CCT affected IOP measured by GAT for groups B and C, whereas it affected IOP measured by DCT only for group C. CONCLUSIONS: IOP measured by DCT was not affected by CCT in eyes with low to normal CCT, whereas this measurement was affected in eyes of high CCT range. CCT may have less effect on IOP measurements using DCT than those obtained by GAT, within a specified range of CCT.
Adult ; Aged ; Aged, 80 and over ; Cornea/ultrasonography ; Female ; Glaucoma/*diagnosis/physiopathology ; Humans ; *Intraocular Pressure ; Male ; Microscopy, Acoustic/methods ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Tonometry, Ocular/*methods ; Young Adult

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