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Letter to the Editor: Quantitative Analysis of Optic Disc Color.

Korean Journal of Ophthalmology.2012;26(3):239-240. doi:10.3341/kjo.2012.26.3.239

No abstract available.
Female ; Humans ; Image Processing, Computer-Assisted/*methods ; Male ; Optic Disk/*physiology ; *Software

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Anterior Ischemic Optic Neuropathy Associated with Udenafil.

In Gun KIM ; Dae Yune KIM

Korean Journal of Ophthalmology.2012;26(3):235-238. doi:10.3341/kjo.2012.26.3.235

We report a case of anterior ischemic optic neuropathy associated with udenafil. A 54-year-old male presented with an acute onset visual field defect of the right eye after udenafil use. Examination revealed a relative afferent pupillary defect and a swollen disc. Automated visual fields revealed an enlarged blind spot and a narrowed visual field. Fluorescein angiography revealed both an inferior choroidal filling delay and an inferior sector filling delay of the optic disc in the arteriovenous phase as well as diffuse leakage of the optic disc in the late phase. Optical coherent tomography revealed increased thickness of the retinal nerve fiber layer, especially in the area of the inferior disc. The patient was counseled to discontinue the use of udenafil and to monitor his blood pressure regularly. The disc swelling was resolved with residual optic atrophy one month after discontinuing the use of udenafil.
Acute Disease ; Choroid/*pathology ; Humans ; Male ; Middle Aged ; Optic Neuropathy, Ischemic/*chemically induced/diagnosis ; Phosphodiesterase 5 Inhibitors/adverse effects ; Pyrimidines/*adverse effects ; Sulfonamides/*adverse effects ; Tomography, Optical Coherence ; Visual Fields

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Indocyanine Green Angiographic Findings of Obscure Choroidal Abnormalities in Neurofibromatosis.

Yong Soo BYUN ; Young Hoon PARK

Korean Journal of Ophthalmology.2012;26(3):230-234. doi:10.3341/kjo.2012.26.3.230

We report two cases of choroidal neurofibromatosis, detected with the aid of indocyanine green angiography (ICGA) in patients with neurofibromatosis (NF)-1, otherwise having obscure findings based on ophthalmoscopy and fluoresceine angiography (FA). In case 1, the ophthalmoscopic exam showed diffuse bright or yellowish patched areas with irregular and blunt borders at the posterior pole. The FA showed multiple hyperfluorescent areas at the posterior pole in the early phase, which then showed more hyperfluorescence without leakage or extent in the late phase. The ICGA showed diffuse hypofluorescent areas in both the early and late phases, and the deep choroidal vessels were also visible. In case 2, the fundus showed no abnormal findings, and the FA showed weakly hypofluorescent areas with indefinite borders in both eyes. With the ICGA, these areas were more hypofluorescent and had clear borders. Choroidal involvement in NF-1 seems to occur more than expected. In selected cases, ICGA is a useful tool to be utilized when an ocular examination is conducted in a patient that has no definite findings based on the ophthalmoscope, B-scan, or FA tests.
Child ; Choroid/*pathology ; Choroid Diseases/*diagnosis/etiology ; Coloring Agents/diagnostic use ; Diagnosis, Differential ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Fundus Oculi ; Humans ; Indocyanine Green/*diagnostic use ; Male ; Middle Aged ; Neurofibromatosis 1/*complications/diagnosis

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Sequential Intrastromal Corneal Ring Implantation and Cataract Surgery in a Severe Keratoconus Patient with Cataract.

Seung Jae LEE ; Hyun Suk KWON ; Il Hwan KOH

Korean Journal of Ophthalmology.2012;26(3):226-229. doi:10.3341/kjo.2012.26.3.226

A 49-year-old man with an uncorrected visual acuity (UCVA) of 20 / 1000, a best spectacle-corrected visual acuity (BSCVA) of 20 / 400, keratometric readings of K1 = 59.88 x 82degrees / K2 = 45.88 x 172degrees, and an inferior steepening that was consistent with keratoconus in his left eye was treated with clear-cornea phacoemulsification and an intraocular lens (IOL) implantation after insertion of keraring intrastromal corneal ring segments for severe keratoconus and cataract. An asymmetrical pair of kerarings was implanted with the assistance of a femtosecond laser in September 2008; the one segment was 250 microm and the other was 150 microm and both were placed at 70degrees. Three months after the kerarings were implanted, clear-cornea phacoemulsification and IOL implantation were performed on the left eye. After surgery, both the UCVA and the BSCVA of the left eye improved by eight lines. Postoperative central keratometry showed a decrease of 7.35 diopters in the left eye. Both the postoperative refraction (-0.75 -0.75 x 60degrees) and the keratometric reading (K1 = 50.05 x 93degrees / K2 = 48.83 x 3degrees) remained stable one month following the procedures. Thus, the sequential order of intrastromal corneal rings implantation and cataract surgery can be considered as a treatment option in patients with severe keratoconus and cataract.
Cataract/*complications/diagnosis ; Corneal Stroma/pathology/*surgery ; Corneal Topography ; Follow-Up Studies ; Humans ; Keratoconus/complications/diagnosis/*surgery ; Lens Implantation, Intraocular/*methods ; Male ; Middle Aged ; Phacoemulsification/*methods ; Severity of Illness Index

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LASIK Interface-Captured Foreign Bodies after Mild Traumatic Corneal Scratch without Flap Displacement.

Jin A CHOI ; Man Soo KIM

Korean Journal of Ophthalmology.2012;26(3):222-225. doi:10.3341/kjo.2012.26.3.222

A 38-year-old woman developed diffusely distributed opacities with crystalline materials in the laser in situ keratomileusis (LASIK) interface of her eye after she was scratched by a sprig during mountain climbing. No sign of flap displacement was noted. Despite two days of topical and systemic antibiotics therapy, the corneal infiltration with interface opacities persisted. The following day, the distribution of the crystalline materials had rotated in a counterclockwise direction. Flap lifting and foreign body removal using sufficient irrigation were performed. One month after surgery, the patient's postoperative uncorrected visual acuity was 0.8 with cleared interface. No signs of epithelial ingrowth or flap striae were noted. Mild traumatic corneal scratching without flap displacement may threaten the integrity of the LASIK interface. If foreign bodies are suspected to be the cause of inflammation, early flap lifting with irrigation is imperative for successful treatment.
Adult ; Cornea/*injuries/pathology/surgery ; Eye Injuries/*complications/diagnosis/surgery ; Female ; Follow-Up Studies ; Humans ; Keratomileusis, Laser In Situ/*methods ; Myopia/surgery ; *Surgical Flaps ; Surgical Wound Dehiscence/diagnosis/*etiology/surgery ; Wounds, Nonpenetrating/*complications/diagnosis/surgery

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Unusual Involvement of IgG4-Related Sclerosing Disease in Lacrimal and Submandibular Glands and Extraocular Muscles.

Yong Un SHIN ; Young Ha OH ; Yoon Jung LEE

Korean Journal of Ophthalmology.2012;26(3):216-221. doi:10.3341/kjo.2012.26.3.216

Chronic sclerosing sialadenitis, also known as Kuttner tumor, is a chronic inflammatory disease of the salivary glands that is reported in a few cases in medical literature. Recent reports suggest that certain aspects of sclerosing diseases, including chronic sclerosing sialadenitis or dacryoadenitis, should be classified under immunoglobulin G4 (IgG4)-related sclerosing disease based on immunohistochemical studies. This study reports an unusual case of IgG4-related sclerosing disease appearing simultaneously in the lacrimal glands, submandibular glands, and extraocular muscles. A 56-year-old male presented with complaints of bilateral eyelid swelling and proptosis that began two years ago. Computed tomography confirmed that bilateral submandibular enlargements also existed five years ago in the subject. Orbital computed tomography and magnetic resonance imaging revealed bilateral lacrimal gland enlargement and thickening of extraocular muscles. Typical findings of chronic sclerosing dacryoadenitis were revealed upon pathologic exam of the right lacrimal gland. Immunostaining revealed numerous IgG4-positive plasma cells. Through these clinical features, we make a diagnosis of IgG4-relataed sclerosing disease in the subject.
Biopsy, Fine-Needle ; Diagnosis, Differential ; Facial Muscles/*immunology/pathology/radiography ; Follow-Up Studies ; Humans ; Immunoglobulin G/*immunology/metabolism ; Immunohistochemistry ; Lacrimal Apparatus/*immunology/metabolism/pathology ; Lacrimal Duct Obstruction/complications/diagnosis/*immunology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Sclerosis ; Submandibular Gland/*immunology/pathology/radiography ; Submandibular Gland Diseases/complications/diagnosis/*immunology ; Tomography, X-Ray Computed

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Frontoethmoidal Mucocele Presenting as Progressive Enophthalmos.

Ji Sun PAIK ; Su Whan KIM ; Suk Woo YANG

Korean Journal of Ophthalmology.2012;26(3):212-215. doi:10.3341/kjo.2012.26.3.212

In this case report we describe a 27-year-old man who presented with progressive enophthalmos for 5 months without any other associated ocular symptoms such as pain, diplopia, or visual disturbance. Computed tomography showed that his progressive enophthalmos originated from a frontoethmoidal mucocele and this caused destruction of the lamina papyracea and shrinkage of the ethmoidal air cell. Finally the enlarged orbital space caused an inward deviation of the eyeball. Endoscopic marsupialization was successfully performed by an otolaryngologist and did not result in any ophthalmologic sequelae. Although frontoethmoidal sinus mucoceles mostly frequently originates from orbital mucoceles, enophthalmic manifestations are very rare. Enophthalmic conditions are not as responsive to surgical interventions as exophthalmic conditions.
Adult ; Diagnosis, Differential ; Endoscopy ; Enophthalmos/diagnosis/*etiology/surgery ; *Ethmoid Sinus ; Follow-Up Studies ; *Frontal Sinus ; Humans ; Male ; Paranasal Sinus Diseases/*complications/diagnosis/surgery ; Time Factors ; Tomography, X-Ray Computed

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Expression of the Na(+)-K(+)-2Cl(-)-Cotransporter 2 in the Normal and Pressure-Induced Ischemic Rat Retina.

Do Hyun KIM ; Myung Douk AHN

Korean Journal of Ophthalmology.2012;26(3):203-211. doi:10.3341/kjo.2012.26.3.203

PURPOSE: To evaluate the expression of the Na(+)-K(+)-2Cl(-)-cotransporter 2 (NKCC2) in the ischemic rat retina. METHODS: Retinal ischemia was induced by pressures 90 to 120 mmHg, above systemic systolic pressure. Immunohistochemistry and western blot analysis were performed. RESULTS: NKCC2 is expressed in the normal retina and its expression is increased by ischemia caused by intraocular pressure elevation. NKCC2 immunoreactivity was observed mainly in axon bundles of ganglion cells and horizontal cell processes in the retina. NKCC2 expression continuously increased with a peak value 3 days (to 415% of normal levels) after ischemic injury, and then gradually decreased to 314% of controls until 2 weeks post injury. The mean density of NKCC2-labeled ganglion cells per mm2 changed from 1,255 +/- 109 in normal retinas to 391 +/- 49 and 185 +/- 37 at 3 days and 2 weeks after ischemia, respectively (p < 0.05), implying cell death of ganglion cells labeled with NKCC2. CONCLUSIONS: Taken together, these results suggest that NKCC2, which is expressed in retinal ganglion and horizontal cells, may contribute to cell death by ischemic injury in the retina, although the molecular mechanisms involved remain to be clarified.
Animals ; Blotting, Western ; Disease Models, Animal ; Immunohistochemistry ; Intraocular Pressure ; Ischemia/etiology/*metabolism ; Male ; Microscopy, Confocal ; Ocular Hypertension/*complications/metabolism/physiopathology ; Rats ; Rats, Sprague-Dawley ; Retinal Diseases/etiology/*metabolism ; Retinal Ganglion Cells/*metabolism/pathology ; Sodium-Potassium-Chloride Symporters/*biosynthesis

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Factors Associated with the Direction of Ocular Deviation in Sensory Horizontal Strabismus and Unilateral Organic Ocular Problems.

In Geun KIM ; Jung Min PARK ; Soo Jung LEE

Korean Journal of Ophthalmology.2012;26(3):199-202. doi:10.3341/kjo.2012.26.3.199

PURPOSE: To evaluate factors associated with the direction of horizontal deviation in the sensory strabismus of patients with unilateral organic amblyopia. METHODS: The medical charts of 53 patients who had been diagnosed with sensory strabismus between 2000 and 2009 were reviewed retrospectively. The underlying ocular disease, time of onset and the duration of vision impairment, refractive error and axial length of the fixing eye, and the direction and angle of deviation were analyzed to determine the distribution of underlying diseases and any factors relevant to determining the direction of the horizontal deviation. RESULTS: Congenital cataracts were the most common underlying disease, found in 33 patients, followed by acquired cataracts, optic nerve disorders, retinal detachment, glaucoma and lens subluxation. Among the 50 patients with horizontal strabismus, 11 had esotropia and 39 had exotropia. The incidence of esotropia was significantly higher when the fixing eye had hyperopia or emmetropia, than when the eye was myopic. Age of onset of vision deterioration and at diagnosis of sensory strabismus, and the axial length of the fixing eye had no relationship to the direction of horizontal deviation. In addition, the duration of visual impairment had no significant relationship with the direction or extent of horizontal deviation. CONCLUSIONS: The most common cause of sensory strabismus was congenital cataracts and the most frequent type of strabismus was exotropia. With respect to the direction of horizontal strabismus, esotropia occurred significantly more often when the refractive error of the fixing eye was hyperopia or emmetropia than when the fixing eye was myopic.
Adolescent ; Adult ; Amblyopia/*complications/physiopathology ; Cataract/complications/congenital/physiopathology ; Child ; Child, Preschool ; Eye Movements/*physiology ; Female ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Male ; Oculomotor Muscles/*physiopathology ; Refractive Errors ; Retrospective Studies ; Risk Factors ; Strabismus/etiology/*physiopathology ; Visual Acuity ; Young Adult

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Contemplation of the Surgical Normogram of Lateral Rectus Recession for Exotropia Associated with Superior Oblique Palsy.

Joo Yeon LEE ; Seung Hyun KIM ; Sung Tae YI ; Tae Eun LEE ; Yoonae A CHO

Korean Journal of Ophthalmology.2012;26(3):195-198. doi:10.3341/kjo.2012.26.3.195

PURPOSE: To suggest a surgical normogram for lateral rectus recession in exotropia associated with unilateral or bilateral superior oblique muscle palsy (SOP). METHODS: We retrospectively reviewed the charts of 71 patients with exotropia who were successfully corrected over one year. Each patient had undergone unilateral or bilateral rectus recession associated with uni- or bilateral inferior oblique (IO) 14 mm recession, using a modified surgical normogram for lateral rectus (LR) recession, which resulted in 1 to 2 mm of reduction of LR recession. We divided all patients into 2 groups, the 34 patients who had undergone LR recession with unilateral IO (UIO) recession group and the remaining 37 patients who had undergone LR recession with bilateral IO (BIO) recession group. Lateral incomitancy was defined when the exoangle was reduced by more than 20% compared to the primary gaze angle. The surgical effects (prism diopters [PD]/mm) of LR recession were compared between the two groups using the previous surgical normogram as a reference (Parks' normogram). RESULTS: The mean preoperative exodeviation was 20.4 PD in the UIO group and 26.4 PD in the BIO group. The recession amount of the lateral rectus muscle ranged from 4 to 8.5 mm in the UIO group and 5 to 9 mm in the BIO group. Lateral incomitancy was noted as 36.4% and 70.3% in both groups, respectively (p = 0.02). The effect of LR recession was 3.23 +/- 0.84 PD/mm in the UIO group and 2.98 +/- 0.62 PD/mm in the BIO group and there was no statistically significant difference between two the groups (p = 0.15). CONCLUSIONS: Reduction of the LR recession by about 1 to 2 mm was successful and safe to prevent overcorrection when using on IO weakening procedure, irrespective of the laterality of SOP.
Child ; Exotropia/complications/physiopathology/*surgery ; Eye Movements ; Female ; Follow-Up Studies ; Humans ; Male ; *Nomograms ; Oculomotor Muscles/physiopathology/*surgery ; Ophthalmologic Surgical Procedures/*methods ; Retrospective Studies ; Treatment Outcome ; Trochlear Nerve Diseases/*complications/physiopathology/surgery

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