Hyeshin Jeon

Goniosynechialysis for secondary angle closure glaucoma in a pseudophakic patient after vitrectomy and silicone oil injection.

Department of Ophthalmology, Pusan National University School of Medicine, Busan 602-739, Korea Medical Research Institute, Pusan National University Hospital, Busan 602-739, Korea 3Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Gyeongsangnam-do 626-770, Korea Correspondence to: Ji-Woong Lee. Department of Ophthalmology, Pusan National University School of Medicine, 1-10, Ami-Dong, Seo-Ku Busan 602-739, Korea. glaucoma@pnu.ac.kr Received: 2013-08-09 Accepted: 2014-02-12

A subconjunctival foreign body confused with uveal prolapse

There are cases in which the presence of a foreign body (FB) is difficult to diagnose based on history taking or clinical examination. We report a case of subconjunctival FB confused with uveal prolapse. A 68-year-old man, who had the history of pterygium excision in his right eye, complained of irritation and congestion in that same eye. He also had the history of growing vegetables in a plastic greenhouse. It seemed to be a suspected uveal mass bulging through a focal scleral thinning site. On the basis of slit-lamp magnification, the lesion was presumed to be a hard and black keratinized mass embedded under the conjunctiva. Histopathologically, the removed mass was revealed to be a seed of the dicotyledones. Patients who show signs of prolapsed uvea or scleral thinning, possibility of a subconjunctival FB should be considered as differential diagnosis. In addition, a removed unknown FB should be examined histopathologically.

Clinical Features of Toxocara-Seropositive Optic Neuritis in Korea

ABSTRACT Purpose: This study was undertaken to analyze the characteristics of optic neuritis in Korean patients seropositive for Toxocara. Methods: We retrospectively reviewed data from patients diagnosed with optic neuritis and followed up for at least one month between 2012 and 2016. Patients were grouped according to Toxocara serological testing outcomes (positive or negative) and clinical characteristics were compared. Results: The seropositive and seronegative groups comprised 13 and 12 patients, respectively. The seropositive patients were older (56.8 years versus 34.5 years), reported ocular pain less frequently (30.8% versus 91.7%), and showed more frequent asymmetric optic disc swelling (72.7% versus 22.2%). During follow-up, visual acuity of all seronegative patients improved to 20/40 or better, compared with 38.5% of the seropositive group. Conclusion: Atypical features such as painless, older age, or asymmetric disc swelling in optic neuritis may be related to seropositivity for Toxocara, suggesting the possibility of undiagnosed Toxocara optic neuropathy.

Thyroid-Stimulating Hormone Receptor Expression on Primary Cultured Human Extraocular Muscle Myoblasts

ABSTRACT Purpose: To isolate and culture human extraocular muscle (EOM) myoblasts and facilitate their differentiation to myotubes in vitro, and to determine whether these myoblasts express thyroid-stimulating hormone receptor (TSHR). Materials and methods: Human EOM myoblasts were isolated from EOM samples, and identified by immunostaining for PAX7 and MYOD1 (markers of human skeletal myoblasts), and western blot for desmin (muscle marker). In addition, we investigated the expressions of SHOX2 (a genetic marker of EOM myoblasts) and HOXC10 (an exclusive marker of hind-limb muscle-derived myoblasts) by RT-PCR. Fusion index and myotube area were measured to quantify myotube differentiation. TSHR immunostaining and western blot were used to determine the presence of TSHR on human EOM myoblasts and investigate its expression during myogenesis. Results: Human EOM myoblasts were immunopositive for PAX7 and MYOD1 staining, and had desmin expression during myogenesis. The EOM-specific gene SHOX2 was detected by RT-PCR, but HOXC10 was not detected. The significant change in both fusion index and myotubes were shown at 8 days after induction of differentiation myotubes. Immunostaining revealed TSHR was expressed on human EOM myoblasts and western blot demonstrated the presence of TSHR protein and highest TSHR protein expression was shown at 10 days after myogenic differentiation. Conclusions: Human EOM myoblasts were cultured and underwent myogenic differentiation in vitro. TSHR protein was detected on human EOM myoblasts and increasing TSHR expression during myogenic differentiation.

Postoperative esotropia: initial overcorrection or consecutive esotropia?

Purpose To investigate the length of time required for diagnosing consecutive esotropia rather than initial overcorrection and examine risk factors for persistent postoperative esotropia after intermittent exotropia surgery. Methods This is a retrospective case series in a tertiary medical center. Fifty consecutive patients with postoperative esotropia ≥6 prism diopters at 1 week following exotropia surgery, managed with nonsurgical management and followed up for more than 6 months from 2014 to 2015, were included. Patients were allocated to 1 of 2 groups depending on whether the postoperative esotropia was resolved at 1 month after surgery. Patients with ongoing nonsurgical management were reevaluated monthly. Timing that significant resolution occurred was assessed. Clinical characteristics and motor and sensory successes were evaluated at 6 months after surgery. Results Thirty-two patients were allocated to group 1 and 18 to group 2. Significant resolution occurred between 1 week and 1 month after surgery. Patients were older and preoperative deviation at distance was larger in group 2 than in group 1 (p = 0.006 and 0.015). A significantly larger proportion of patients in group 2 showed combined vertical deviation (p = 0.019). Motor and sensory success rates were comparable. Conclusions When initial postoperative esotropia persists for more than 1 month, it should be regarded as consecutive esotropia. Older age, a larger preoperative deviation, and concurrent vertical deviation are risk factors for persistent postoperative esodeviations. Therefore, more postoperative attention should be given to these patients.

Long-Term Surgical Outcomes of Early Surgery for Intermittent Exotropia in Children Less than 4 Years of Age

ABSTRACT Purpose: To investigate the long-term outcomes of intermittent exotropia surgery for children less than 4 years of age. Materials and Methods: Consecutive patients who underwent surgery for intermittent exotropia and had follow-up durations longer than 2 years were recruited. The patients were classified according to age at surgery—the patients of group 1 had undergone surgery before 4 years of age and those of group 2 at or after 4 years of age. Motor success was defined by exodeviation < 10 prism diopters (PD) and esodeviation < 5 PD at distance at 2 years postoperatively. Stereoacuity was considered as success at a value ≤ 60 arc seconds. The motor and sensory success rates as well as the surgical complications were compared. Results: Of the 73 patients, 36 were allocated to group 1 and 37 to group 2. At 2 years after surgery, 13 of the 36 (36.1%) patients in group 1 and 12 of the 37 (32.4%) in group 2 had achieved successful alignment; 32 (88.9%) patients in group 1 and 35 (94.6%) in group 2 achieved normal stereoacuity. No significant differences in the motor or sensory success rates were observed between the two groups (p = 0.46 and 0.32, respectively). Conclusions: The surgical success rates for intermittent exotropia were comparable between the patients operated upon before 4 years of age and those operated upon after 4 years of age. The incidence of postsurgical complications was low and not significantly different between the two study groups.

Strabismus in children with white matter damage of immaturity: MRI correlation

Background/aims To investigate the correlation between strabismus and the severity of white matter damage of immaturity (WMDI), based on MRI findings. Although strabismus is commonly associated with WMDI, its clinical features are not well established. Methods This cross-sectional study involved 73 consecutive patients who visited the department of ophthalmology and were diagnosed with WMDI. The severity of WMDI was graded based on the MRI findings of the patients. All of the patients underwent complete ophthalmic examination, and strabismus was characterised in terms of direction, constancy, and angle of deviation. The prevalence and the characteristics of strabismus and their correlation with the grade of WMDI were investigated. Results The perinatal characteristics, age at MRI, and the number of MRIs per child did not differ between different grades of WMDI. Refractive errors, found in 56 (76.7%) patients, did not differ between the grades of WMDI either. Strabismus was observed in 38 (52.1%) patients, and its prevalence increased with the grade of the disorder; 20 patients had exotropia and 18 had esotropia. Constant strabismus was found more frequently in patients with higher grade WMDI. However, the direction and angle of deviation did not differ depending on the grade of WMDI. Conclusions The prevalence of strabismus increased with the severity of WMDI and was higher among patients with WMDI than among healthy individuals. The severity of WMDI might be related to the presence and constancy of strabismus.

Abnormal medial rectus insertion presenting exotropia: a case report and review of the literature.

Dear Editor, I am Dr. Heeyoung Choi, from the Department of Ophthalmology of Pusan National University Hospital, Busan, Korea. I write to present a case report of abnormal medial rectus insertion presenting exotropia. Isolated anatomical abnormalities of the extraocular muscles without craniofacial syndromes or other systemic anomalies are not common. In most of the cases, strabismus is usually combined with incomitance and abnormal ocular movement. There are a few reports of isolated anomalies of the medial rectus muscle . We report a case that an exotropic patient with abnormal insertion of the medial rectus muscle who achieved successful surgical outcome. A 16-year-old boy was referred to our clinic because of exotropia. He first noticed his eyes exodeviated when he was 7 years old. He denied any treatment, both non-surgical and surgical. His best corrected visual acuity was 20/40 in the right eye and 20/20 in the left eye. Refractive error was +0.5 diopters in the right eye and -1.0 diopters in the left eye. He had constant exotropia of 40 prism diopters upon distance and near fixation testing by prism and alternative cover test. He had poor stereoacuity (200 seconds of arc) which was evaluated by the titmus test. His near point of convergence was 30 cm. Duction and version was within normal range. He did not have any systemic disease or previous history of ophthalmic surgery. We planned to perform right lateral rectus recession combined with right medial rectus resection. There were no abnormal findings in intraoperative forced duction test. After performing 7.5 mm of recession of the right lateral rectus muscle, which was normally inserted, we noticed that the right medial rectus was attached to the sclera 12 mm from the limbus. The muscle itself looked healthy and of a normal size. The left medial rectus muscle was also attached 12 mm away from the limbus (Figure 1). This finding required a modification of the planned surgical procedure. Instead of resection, we decided to perform advancement of the medial rectus by 5 mm. Limitation of ocular movement or symptomatic diplopia was not occurred after surgery. One year after surgery, the patient maintained orthotropia (Figure 2). There are only a few reports about anomalies of the medial rectus muscle, presenting comitant strabismus . Choi [2]