This report described one case of acupuncture treatment for acquired paralytic strabismus. Acupoints included bilateral Fengchi (GB20), Sibai (ST2), Taiyang (EX-HN5), Tongziliao (GB1), Jiexi (ST41), and Taichong (LR3). Fengchi (GB20) was treated with the deep-needling nayang technique, Jiexi (ST41) with the qinglong baiwei method, and the remaining acupoints with conventional acupuncture techniques. Needles were retained for 40 min, once daily, six times per week. After two months of treatment, the patient's diplopia resolved, the right eye exhibited flexible abduction, and the ocular position returned to orthotropia. Follow-up over one year showed no recurrence.
Humans ; Acupuncture Points ; Acupuncture Therapy ; Strabismus/therapy*

PURPOSE: To report a case where bilateral malignant retrobulbar lymphoma was diagnosed after repetitive intraocular lens dislocation to the anterior chamber. CASE SUMMARY: An 85-year-old male with a history of stroke who had undergone cataract surgery 10 years ago at another hospital presented with repeated intraocular lens (IOL) dislocations of both eyes into the anterior chamber. He had previously undergone IOL scleral fixation once in his left eye and twice in his right eye, but IOL dislocation was still repeatedly occurring. The best-corrected visual acuity was 0.4 in both eyes. Hertel exophthalmetry was 20 mm in his right eye and 18 mm in his left eye. Painless limitation of motion at supraduction was observed in the right eye. Funduscopy showed newly appeared choroidal folding in the right eye, so orbital computed tomography (CT) with contrast was performed. The CT scans showed bilateral homogenously enhancing retrobulbar masses. Biopsy of the masses showed a MALToma. After radiation therapy, the choroidal folds resolved and exophthalmetry improved to 10 mm in both eyes. No additional IOL dislocation occurred. During 2.5 years of follow-up, there was no evidence of recurrence or distant metastasis of the MALToma. CONCLUSIONS: Orbital lymphomas can cause lid edema, exophthalmos, strabismus, and diplopia, and can be diagnosed with imaging modalities such as CT. Final diagnosis involves biopsy and radiation therapy or chemotherapy. If IOL dislocation occurs repeatedly, it may result from an increase in retrobulbar pressure, and concurrent choroidal folding using funduscopy is strongly recommended for imaging to check for the presence of retrobulbar masses.
Aged, 80 and over ; Anterior Chamber ; Biopsy ; Cataract ; Choroid ; Diagnosis ; Diplopia ; Dislocations* ; Drug Therapy ; Edema ; Exophthalmos ; Follow-Up Studies ; Humans ; Lenses, Intraocular* ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Male ; Neoplasm Metastasis ; Orbit ; Recurrence ; Strabismus ; Stroke ; Tomography, X-Ray Computed ; Visual Acuity

OBJECTIVE: To evaluate the change in accommodative lag and accommodation convergence/accommodation (AC/A) after patients with myopia wear orthokeratology lenses. 
 METHODS: A total of 48 myopic subjects (a test group), who wore orthokeratology lenses regularly, and 48 myopic subjects (a control group), who wore spectacles regularly, were enrolled for this study from January 2011 to January 2013 in Optometric Center, the Forth Hospital of Changsha. Accommodative lag was measured by fused cross cylinder method, where the patients should gaze at the front optotypes 40 cm away. Gradient of the AC/A ratio was measured by Von Grafe method to check closer distance heterophoria. Accommodative lag and AC/A ratio were analyzed by statistics.
 RESULTS: After 1-year follow-up, accommodative lag and AC/A rate in patients with low or moderate myopia in the test group was decreased in 1, 3, 6 months or 1 year compared with that in the control group (P<0.05). 
 CONCLUSION Compared with spectacles, orthokeratology lenses are able to decrease accommodative lag and high AC/A rate in patients with low or moderate myopia. The relationship between accommodation and convergence is improved by orthokeratology lenses. Orthokeratology is an effective way to control myopia.
Accommodation, Ocular ; Case-Control Studies ; Contact Lenses ; Eyeglasses ; Humans ; Myopia ; therapy ; Orthokeratologic Procedures ; Strabismus

PURPOSE: Diencephalic syndrome is an uncommon cause of failure to thrive in early childhood that is associated with central nervous system neoplasms in the hypothalamic-optic chiasmatic region. It is characterized by complex signs and symptoms related to hypothalamic dysfunction; such nonspecific clinical features may delay diagnosis of the brain tumor. In this study, we analyzed a series of cases in order to define characteristic features of diencephalic syndrome. METHODS: We performed a retrospective study of 8 patients with diencephalic syndrome (age, 5-38 months). All cases had presented to Seoul National University Children's Hospital between 1995 and 2013, with the chief complaint of poor weight gain. RESULTS: Diencephalic syndrome with central nervous system (CNS) neoplasm was identified in 8 patients. The mean age at which symptoms were noted was 18+/-10.5 months, and diagnosis after symptom onset was made at the mean age of 11+/-9.7 months. The mean z score was -3.15+/-1.14 for weight, -0.12+/-1.05 for height, 1.01+/-1.58 for head circumference, and -1.76+/-1.97 for weight-for-height. Clinical features included failure to thrive (n=8), hydrocephalus (n=5), recurrent vomiting (n=5), strabismus (n=2), developmental delay (n=2), hyperactivity (n=1), nystagmus (n=1), and diarrhea (n=1). On follow-up evaluation, 3 patients showed improvement and remained in stable remission, 2 patients were still receiving chemotherapy, and 3 patients were discharged for palliative care. CONCLUSION: Diencephalic syndrome is a rare cause of failure to thrive, and diagnosis is frequently delayed. Thus, it is important to consider the possibility of a CNS neoplasm as a cause of failure to thrive and to ensure early diagnosis.
Astrocytoma ; Brain Neoplasms ; Central Nervous System ; Central Nervous System Neoplasms ; Diagnosis ; Diarrhea ; Drug Therapy ; Early Diagnosis ; Failure to Thrive* ; Follow-Up Studies ; Head ; Humans ; Hydrocephalus ; Hypothalamic Diseases ; Infant* ; Optic Nerve Glioma ; Palliative Care ; Retrospective Studies ; Seoul ; Strabismus ; Vomiting ; Weight Gain

Retinoblastoma is a rare disease, but most common tumor which arises in eye. It can affect one or both eyes, and the main pathophysiology is explained by the "Two-hit theory" - the germline mutation of the RB1 gene. Most common clinical symptoms are leuocoria, strabismus, poor visual tracking, glaucoma, and orbital cellulitis. Diagnosis is made by ophthalmologist through fundoscopic examination; Examination under General Anesthesia (EUA) is recommended until the age 3. Orbital CT and MRI can detect the tumor invasion on optic nerve, central nervous system. CSF studies, examination of bone is helpful if the distant metastasis is suspected. Biopsy is rarely done unless in the case of enucleation. Enucleated eye should be explored for the invasion to the optic nerve, choroid, anterior chamber, iris and pupil. Treatment strategies can be different according to the disease status. If the single eye is involved, the treatment goal will be the removal of tumor and prevention of relapse. Local therapies include cryotherapy, laser photocoagulation, thermotherapy can be the choice, and if the tumor is too large for the local therapy, enucleation should be concerned. Nowadays, chemo-reduction combined with local therapy, intra-arterial and intravitreous chemotherapeutic agent injections are studied to avoid enucleation. In bilateral retinoblastoma, multidisciplinary treatments include chemoreduction, external beam radiotherapy, local therapy and other experimental therapies are needed: like intra-arterial injection, intra-vitreal injection, and high-dose chemotherapy with autologous stem cell transplantation. Early detection of retinoblastoma is important to save the vision and eyeball.
Anesthesia, General ; Anterior Chamber ; Biopsy ; Central Nervous System ; Choroid ; Cryotherapy ; Diagnosis ; Drug Therapy ; Eye Enucleation ; Germ-Line Mutation ; Glaucoma ; Hyperthermia, Induced ; Injections, Intra-Arterial ; Intravitreal Injections ; Iris ; Light Coagulation ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Optic Nerve ; Orbit ; Orbital Cellulitis ; Pupil ; Radiotherapy ; Rare Diseases ; Recurrence ; Retinoblastoma ; Stem Cell Transplantation ; Strabismus ; Therapies, Investigational

It is commonly accepted that albino patients with strabismus rarely achieve binocularity and depth perception after strabismus surgery. The presence of retino-geniculo-cortical misrouting, a hallmark of the visual system in albinism, does not necessarily cause total loss of binocular vision, however, not even in albino patients with strabismus. Recently some degrees of stereopsis were reported in albinism patients with minimal clinical nystagmus, if any, in the absence of strabismus. It is possible that patients with albinism and strabismus have binocular visual potential which appears after strabismus correction and provides appropriate postoperative alignment in the long term. Here we present two cases of clinically diagnosed oculocutaneous albinism, an 18-year-old girl and a 16-year-old boy, both with exotropia > or =40 prism diopter, who gained acceptable alignment and fusion after surgical correction of their strabismus as demonstrated on Bagolini testing. In cases of albinism accompanied by visual pathway abnormalities and strabismus, binocular visual potential is not impossible, and some levels can be expected. Thus, these patients, like other cases of strabismus, may benefit from treatment of strabismus at an earlier age to achieve appropriate alignment, cosmetic satisfaction, and a possibly increased chance of fusion.
Adolescent ; Albinism, Oculocutaneous/*drug therapy/*surgery ; Botulinum Toxins, Type A/*therapeutic use ; Combined Modality Therapy ; Female ; Humans ; Male ; Neuromuscular Agents/therapeutic use ; Strabismus/*drug therapy/*surgery ; Treatment Outcome ; Visual Pathways/drug effects/surgery

In this case series study, we assessed the effects of recession-resection surgery augmented with botulinum toxin A chemodenervation for patients with chronic paralytic horizontal strabismus. In addition, we compared these effects with those of full tendon transposition (FTT) augmented with posterior intermuscular suture (PIMS). Ten patients who underwent strabismus surgery due to paralytic horizontal strabismus were retrospectively reviewed. They received a recession-resection surgery augmented with botulinum toxin A chemodenervation (type I surgery) or a FTT augmented with PIMS (type II surgery). The preoperative angle of deviation (AOD) and postoperative improvement in AOD were compared according to the type of procedure. The preoperative AOD was 60.00 +/- 28.50 prism diopters (PD) for type I surgery and 68.00 +/- 27.06 PD for type II (p = 0.421). Improvement in AOD was 53.20 +/- 25.01 PD for type I surgery and 44.20 +/- 18.74 PD for type II (p = 0.548). Recession-resection surgery augmented with botulinum toxin A chemodenervation is a concise and effective procedure for treating paralytic horizontal strabismus.
Adolescent ; Botulinum Toxins, Type A/*therapeutic use ; Humans ; Male ; Middle Aged ; Nerve Block/*methods ; Neuromuscular Agents/*therapeutic use ; Oculomotor Muscles/*transplantation ; Ophthalmologic Surgical Procedures/*methods ; Strabismus/etiology/*therapy ; Suture Techniques ; Tendon Transfer/*methods

OBJECTIVETo compare therapeutic effects of acupuncture at local points of eye and western medicine on paralytic strabismus.

METHODSOne hundred cases were randomly divided into an acupuncture group and a medication group. The acupuncture group (58 cases) was treated with acupuncture at local points of eye, Jingming (BL 1), Tongziliao (GB 1), Shangming (Extra) etc. were selected; and the medication group (42 cases) was treated with oral administration of Methycobal and Vitamin B1. After treatment of 5 courses, the therapeutic effects in the two groups were observed.

RESULTSThe total effective rate of 94.8% in the acupuncture group was superior to that of 85.7% in the medication group (P<0.01); the therapeutic effects of the acupuncture group for treatment of oculomotor nerve and abducent nerve were significantly better than that of the medication group (P<0.05); the acupuncture group was better than the medication group in synoptophore examination results and improvement of rima oculi and pupil (P<0.01, P<0.05), the acupuncture group was superior to the medication group in improvement of the function of paralysis eye muscle, including medial rectus and lateral rectus except superior oblique (P<0.01, P<0.05).

CONCLUSIONAcupuncture on local points of eye is an effective therapy for paralytic strabismus.

Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Child ; Eye Movements ; drug effects ; Female ; Humans ; Male ; Middle Aged ; Paralysis ; drug therapy ; physiopathology ; therapy ; Strabismus ; drug therapy ; physiopathology ; therapy ; Thiamine ; administration & dosage ; Young Adult

OBJECTIVETo observe clinical therapeutic effect of acupuncture on diabetic paralytic squint.

METHODSSeventy-two cases of diabetic paralytic squint were randomly divided into a medication group, an acupuncture group and an acupuncture and medication group. The medication group were treated with intramuscular injection of Methyl vitamin B12 250 microg, once daily; the acupuncture group were treated by acupuncture at different acupoints according to different paralytic muscles of eyes with adjuvant acupoints selected according to symptoms; the acupuncture and medication group were treated with the routine medicine and acupuncture. The treatment was given for 28 days.

RESULTSThe total effective rate of 87. 5% in the acupuncture group and 95.7% in the acupuncture and medication group were higher than 54.5% in the medication group (P < 0.05, P < 0.01), with no significant difference between the acupuncture group and the acupuncture and medication group (P > 0.05).

CONCLUSIONAcupuncture has a definite therapeutic effect on diabetic paralytic squint, which is better than that of routine medication.

Acupuncture Therapy ; Adult ; Diabetic Nephropathies ; therapy ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Strabismus ; therapy

OBJECTIVETo find out a better therapy for paralytic strabismus.

METHODSNinety cases were randomly divided into an acupuncture-medicine group, an acupuncture group, a western medicine group, 30 cases in each group. The acupuncture-medicine group were treated with acupuncture at Shuigou (GV 26), Fengchi (GB 20), Yifeng (TE 17), Yiming (EX-HN 14), Taiyang (EX-HN 5), Jingming (BL 1), Cuanzhu (BL 2), etc. intramuscular injection of Vit B1 and Vit B12, and oral administration of ATP; the acupuncture group were treated with simple acupuncture, and the western medicine group were treated with simple western medicine. Their therapeutic effects were compared.

RESULTSThe cured rate of 66.7% in the acupuncture-medicine group was significantly higher than 26.7% in the acupuncture group and 26.7% in the western medicine group (both P < 0.01).

CONCLUSIONAcupuncture combined with western medicine has obvious therapeutic effect, which is better than that of simple acupuncture or simple western medicine.

Acupuncture Therapy ; Aged ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Ophthalmoplegia, Chronic Progressive External ; therapy ; Strabismus ; therapy