PURPOSE: To evaluate the age-related risk factors, clinical manifestations, and prognosis in infectious keratitis. METHODS: Records of patients with infectious keratitis who visited one of the two tertiary medical centers at Jeolla-do from January 2000 to December 2007 were reviewed. Risk factors depending on patient age distribution standardized over and under the age of 60 were reviewed retrospectively by analyzing sex, age, previous history of trauma, systemic disease, previous ocular disease, causative organism and treatment. RESULTS: A total of 757 patients (757 eyes) visited either one of the two tertiary medical centers. The mean age was 58.2+/-18.0 (4 to 93) years, and patients included 437 males (57.7%), and 320 females (42.3%). The most common risk factor among all age groups was trauma, especially due to vegetable matter. The second most frequent risk factor among the younger patients was contact lens use (19.2%), and common risk factors among the elderly were previous ocular disease (20.0%), systemic disease (15.5%), and ocular surgery (9.7%). The most prevalent causative organisms among all age groups were Gram-positive bacteria, in particular Staphylococcus epidermidis. Elderly patients had a higher frequency of corneal perforation than did younger patients. In addition, elderly patients had a worse prognosis and more often required surgical treatment. CONCLUSIONS: Infectious keratitis has more severe clinical manifestations and complications and a worse prognosis in elderly than in younger patients. Elderly patients have more diverse risk factors. Prevention should aim at avoiding ocular trauma, especially by vegetable matter, and at controlling ocular surface diseases, such as exposure keratitis and bullous keratopathy.
Age Distribution ; Aged ; Corneal Perforation ; Female ; Gram-Positive Bacteria ; Humans ; Keratitis ; Male ; Prognosis ; Retrospective Studies ; Risk Factors ; Staphylococcus epidermidis ; Vegetables

Neural stem cells (NSCs) have mainly been applied to neurodegeneration in some medically intractable neurologic diseases. In this study, we established a novel NSC line and investigated the cytotoxic responses of NSCs to exogenous neurotoxicants, glutamates and reactive oxygen species (ROS). A multipotent NSC line, B2A1 cells, was established from long-term primary cultures of oligodendrocyte-enriched cells from an adult BALB/c mouse brain. B2A1 cells could be differentiated into neuronal, astrocytic and oligodendroglial lineages. The cells also expressed genotypic mRNA messages for both neural progenitor cells and differentiated neuronoglial cells. B2A1 cells treated with hydrogen peroxide and L-buthionine-(S,R)-sulfoximine underwent 30-40% cell death, while B2A1 cells treated with glutamate and kainate showed 25-35% cell death. Cytopathologic changes consisting of swollen cell bodies, loss of cytoplasmic processes, and nuclear chromatin disintegration, developed after exposure to both ROS and excitotoxic chemicals. These results suggest that B2A1 cells may be useful in the study of NSC biology and may constitute an effective neurotoxicity screening system for ROS and excitotoxic chemicals.
Animals ; Brain/*cytology ; Buthionine Sulfoximine/pharmacology ; Cell Differentiation ; Cell Line ; Cell Lineage ; Cytokines/pharmacology ; Enzyme Inhibitors/pharmacology ; Excitatory Amino Acid Agonists/pharmacology ; Glutamic Acid/pharmacology ; Humans ; Hydrogen Peroxide/pharmacology ; Intercellular Signaling Peptides and Proteins/pharmacology ; Kainic Acid/pharmacology ; Mice ; Mice, Inbred BALB C ; Multipotent Stem Cells/cytology/*drug effects/physiology ; Neuroglia/cytology/drug effects/physiology ; Neurons/cytology/*drug effects/physiology ; Neurotoxins/*pharmacology ; Oxidants/pharmacology ; Phenotype ; Reactive Oxygen Species/metabolism

PURPOSE: The present study was performed to evaluate the changes in tear film and ocular surface parameters after using sodium hyaluronate (SH) 0.1% alone or in combination with cyclosporine A (CsA) 0.05% in patients with thyroid-associated ophthalmopathy accompanied by dry eye. METHODS: A total of 72 eyes from 36 patients were divided into two groups; 36 eyes of 18 patients were treated with 0.1% SH alone (group 1), and 36 eyes of 18 patients were treated with SH 0.1% and CsA 0.05% (group 2). Tear break-up time (BUT), basal tear secretion test (BST), tear clearance rate (TCR), fluorescein staining (FS) and corneal sensitivity test (CST) were evaluated at pre-treatment and one, three and six months post-treatment. Conjunctival impression cytology was performed and tear CXCL11 (Chemokine (C-X-C motif) ligand) levels were measured pre-treatment and three months post-treatment. RESULTS: BUT, BST, TCR, KEP and CST were significantly improved at six months in group 1 (p < 0.05) and at three months in group 2 (p < 0.05). The degree of conjunctival squamous cell metaplasia, goblet cell density and tear CXCL11 levels were significantly changed at three months in group 2 (p < 0.05). However, there were no significant changes in group 1 after 3 months. CONCLUSIONS: Combined use of topical 0.1% SH and 0.05% CsA can result in early improvement in tear films and ocular surface parameters in patients with thyroid-associated ophthalmopathy accompanied by dry eye.
Cyclosporine ; Dry Eye Syndromes ; Eye ; Fluorescein ; Goblet Cells ; Graves Ophthalmopathy ; Humans ; Hyaluronic Acid ; Metaplasia ; Tears ; Thyroid Gland

PURPOSE: To investigate changes in corneal astigmatism and refractive power in intermittent exotropia after lateral rectus recession with or without medial rectus resection. METHODS: We compared visual acuity, spherical equivalent, refractive power, astigmatism from cycloplegic refraction, and Orbscan corneal topography in two groups consisting of 40 eyes from 20 patients who underwent bilateral lateral rectus recession (Group 1) and 33 eyes from 33 patients who underwent monocular medial rectus resection with lateral rectus recession (Group 2) immediately preoperatively and at 1 and 4 weeks postoperatively. RESULTS: In Group 1, the refractive power changed +0.12 D on average in the horizontal median and -0.08 D on average in the vertical median at 1 week postoperatively. The refractive power changed +0.07 D on average in the horizontal median and -0.04 D on average in the vertical median at 4 weeks postoperatively. No significant change in the corneal astigmatic axis was detected. In Group 2, the refractive power changed +0.4 D on average in the horizontal median and -0.19D on average in the vertical median, and the corneal astigmatic axis significantly shifted by +0.51 D in the 'with-the-rule astigmatism' direction at 1 week postoperatively (p=0.02). However, the refractive power changed +0.2 D on average in the horizontal median and -0.09 D on average in the vertical median, and the corneal astigmatic axis changed +0.2 D at 4 weeks postoperatively, although these values were not statistically significant. CONCLUSIONS: Postoperative refractive power and corneal astigmatism did not change significantly, as compared to preoperative values, at 4 weeks postoperatively in the lateral rectus recession-only or medial-and-lateral rectus recession group.
Astigmatism ; Axis, Cervical Vertebra ; Corneal Topography ; Exotropia ; Eye ; Humans ; Muscles ; Visual Acuity

PURPOSE: To report several cases of secondary infection by fungus in herpes simplex keratitis. CASE SUMMARY: A retrospective chart review was performed on 3 eyes of 3 patients who were without improvement and diagnosed with fungal keratitis by smear and culture on prior presentation with herpetic keratitis. Two cases were diagnosed with fungal keratitis, based on the results of culture. Fungal keratitis by Candida albicans was improved with antifungal agents, but a case caused by Fusarium species was more aggravated, regardless of antifungal agents. One case was improved by antifungal medications, which was diagnosed with fungal keratitis by the fungal hyphae manifestation on KOH preparation. CONCLUSIONS: Secondary microbial infection should be considered, when the lesion had no improvement with antiviral agents in herpetic keratitis.
Antifungal Agents ; Antiviral Agents ; Candida albicans ; Coinfection ; Eye ; Fungi ; Fusarium ; Herpes Simplex ; Humans ; Hyphae ; Keratitis ; Keratitis, Herpetic ; Methylmethacrylates ; Polystyrenes ; Retrospective Studies

PURPOSE: To evaluate the long-term results of Descemet's stripping automated endothelial keratoplasty in Korea (DSAEK). METHODS: Seven patients with bullous keratopathy who underwent DSAEK and who were followed-up for more than 18 months were reviewed retrospectively. Best corrected visual acuity, refraction, corneal thickness, and endothelial cell count were examined before and after surgery. RESULTS: The mean follow-up period was 19.9 +/- 2.9 months (18 to 24 months), and the mean age was 61.42 +/- 10.13 years (46 to 76 years). Six patients (85.7%) showed successful results after surgery. Best corrected visual acuity (logMAR) was significantly improved from 1.62 (median) to 1.15 (median) (p = 0.027) at one month after surgery and was maintained until the final follow-up period. There were no statistical differences in spherical ametropia or astigmatism before or 18 months after the operation. Graft failure was observed in one case, in which penetrating keratoplasty was performed 12 months after DSAEK. CONCLUSIONS: Long term results of DSAEK showed fast visual recovery, low ametropia and astigmatism. DSAEK may be a good option for the surgical management of corneal endothelial disease.
Astigmatism ; Corneal Transplantation ; Endothelial Cells ; Follow-Up Studies ; Humans ; Keratoplasty, Penetrating ; Korea ; Refractive Errors ; Retrospective Studies ; Transplants ; Visual Acuity

PURPOSE: To determine the surgical outcome of intermittent exotropia according to preoperative retinal correspondence with the Bagolini striated glasses test and the relationships between the Worth-4-dot test or stereoacuity with the B-VAT test. METHODS: We analyzed retrospectively preoperative fusion statuses with the Worth-4-dot test, stereoacuity with the B-VAT test and retinal correspondence with the Bagolini striated glasses test to determine any possible relationships with surgical outcome. The surgical outcome and binocular function were further investigated six months postoperatively in 114 patients who had undergone surgery for intermittent exotropia. RESULTS: The surgical outcome according to preoperative fusion status and stereoacuity was not statistically significant(p=0.38, p=0.59). whereas, preoperative retinal correspondence with the Bagolini striated glasses test was statistically significant(p<0.01). More over there was a relationship between retinal correspondence and fusion status or stereoacuity(p<0.01, p<0.01). CONCLUSIONS: The preoperative Bagolini striated glasses test was the factor predicting a favorable surgical outcome and there was a relationship between the preoperative Worth-4-dot test and the B-VAT test.
Exotropia ; Eyeglasses ; Glass ; Humans ; Retinaldehyde ; Retrospective Studies ; Telescopes

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

PURPOSE: To present a surgical result of rectus muscle transposition with silicone band without suture on the sclera in strabismus fixus with high myopia. CASE SUMMARY: A 73-year-old female patient with a 20-year history of bilateral esotropia and hypotropia visited our clinic. The patient`s right eye was aphakic because crystalline lens removal was performed 17 years earlier and the left eye was phthisical after retinal detachment, due to high myopia. Ocular movements in both eyes were severely restricted in all directions with the cornea barely visible. Ultrasound examination revealed posterior staphyloma of the retina. The axial length measurement was 32 mm in the right eye, and could not be measured in the left eye. Posterior tenon fixation of the medial rectus and inferior rectus muscle tendon was performed, in addition, fixation of the lateral half of the superior rectus and superior half of the lateral rectus muscle on the silicone band 10 mm posterior to each muscle's scleral insertion as a transposition procedure was performed. At 6 months postoperatively, there was no residual esotropia or hypotropia. The right eye maintained a gaze limitation but improved abduction and supraduction. CONCLUSIONS: In strabismus fixus with high myopia, posterior tenon fixation and muscle transposition with silicone band is an effective method without complication.
Aged ; Cornea ; Esotropia ; Eye ; Female ; Humans ; Lens, Crystalline ; Muscles ; Myopia ; Retina ; Retinal Detachment ; Sclera ; Silicones ; Strabismus ; Sutures ; Tendons

PURPOSE: To investigate bilateral medial rectus recession by considering functional equator as a surgical guideline in esotropia over 40 prism diopters (PD). METHODS: Forty-one patients who underwent bilateral medial rectus recession, and were followed-up for more than 12 months, were reviewed. The success rate was compared between group 1 and group 2, which were divided to recession site from the functional equator posterior, and also between the hyperopia group and myopia group according to refraction. RESULTS: According to preoperative deviation angle, 21 patients underwent recession to less than 10 mm posterior to the functional equator (group 1) and 20 patients had recession to 1.5 mm to 2.0 mm posterior to the functional equator (group 2). No significant difference in success rate between group 1 (71.4%) and group 2 (75.0%) was detected at the last follow-up. When divided into a hyperopia group (26 patients) and myopia group (15 patients), the success rate in the myopia group was higher than in the hyperopia group, as observed at the last follow-up, but the difference was not significant. There was 1 case of overcorrection in each group. CONCLUSIONS: A successful outcome was achieved in 30 patients (73.2%), and overcorrection in 2 patients (4.9%) when recessed to 2.0 mm posterior to functional posterior in esotropia over 40PD.
Esotropia ; Follow-Up Studies ; Humans ; Hyperopia ; Myopia