JunHyuk Son

Visual Loss in One Eye after Spinal Surgery

Purpose To report a patient who developed an unusual combination of central retinal artery occlusion with ophthalmoplegia following spinal surgery in the prone position. Methods A 60-year-old man underwent a cervical spinal surgery in the prone position. Soon after recovery he could not open his right eye and had ocular pain due to the general anesthesia. Upon examination, we determined that he had a central retinal artery occlusion with total ophthalmoplegia. Results Despite medical treatment, optic atrophy was still present at the following examination. Ptosis and the afferent pupillary defect disappeared and ocular motility was recovered, but visual loss persisted until the last follow-up. Conclusions A prolonged prone position during spinal surgery can cause external compression of the eye, causing serious and irreversible injury to the orbital structures. Therefore, if the patient shows postoperative signs of orbital swelling after spinal surgery the condition should be immediately evaluated and treated.

Extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue type of the ocular adnexa: Retrospective single institution review of 95 patients

Context: There are few reports on the management of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type (MALT), which are based on the experience of a single institution, as opposed to large multicenter randomized trials. Aim: The aim of this study was to report on the clinical experience of a single institution. Materials and Methods: A retrospective review was undertaken of records of 95 patients with MALT lymphoma of the ocular adnexa. Histologic diagnosis of MALT lymphoma was made according to established criteria, and clinical staging was carried out to determine treatment modalities. All patients were treated by external beam irradiation (30.6–45.0 Gy) after biopsy. Additional chemotherapy was performed in accordance with the clinical stage of the disease. All the patients were treated by the same hemato-oncologist and radio-oncologist. Results: Almost all patients showed complete response, except for four patients who showed partial response. In two of 95 patients, contralateral eye showed recurrence, and they were salvaged by additional radiotherapy. The 3-year overall survival and event-free survival rates were 100 and 97%, respectively, by Kaplan–Meier survival analysis. Moreover, there were no serious radiation-associated complications. Conclusions: Radiotherapy alone can be an important treatment modality for the local control and survival in patients with localized MALT lymphoma of ocular adnexa. Systemic chemotherapy should be considered in patients with advanced stage disease.

A case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis.

We report a rare case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis. A 15-year-old male visited our hospital for an acute drop of the left eyelid and diplopia. He has been on anti-tuberculous drugs (isoniazid, rifampin) for 1 year for his tuberculous encephalitis. A neurological examination revealed a conscious clear patient with isolated left oculomotor nerve palsy, which manifested as ptosis, and a fundus examination revealed choroidal tuberculoma. Other anti-tuberculous drugs (pyrazinamide, ethambutol) and a steroid (dexamethasone) were added. After 3 months on this medication, ptosis of the left upper eyelid improved and the choroidal tuberculoma decreasedin size, but a right homonymous visual field defect remained. When a patient with tuberculous meningitis presents with abrupt onset oculomotor nerve palsy, rapid re-diagnosis should be undertaken and proper treatment initiated, because the prognosis is critically dependent on the timing of adequate treatment.

Comparison of experimental porous silicone implants and porous silicone implants

BackgroundTo investigate the extent and pattern of fibrovascular ingrowth of porous silicone sphere implants compared to porous polyethylene implants.MethodsExperimental porous silicone sphere implants and porous polyethylene implants were implanted in the left socket of 20 New Zealand white rabbits after enucleation. Fibrovascular ingrowth and maturation was evaluated at 4 weeks and 8 weeks after implantation by histopathologic examination and scanning electron microscope.ResultsAt 4 weeks after surgery, porous polyethylene implants showed deeper fibrovascular ingrowth than porous silicone sphere implants; 42.4% versus 34.2% of radius of the implants respectively (p = 0.047). However there was no significant difference in the depth of fibrovascular ingrowth between the two groups at 8 weeks after implantation, although porous polyethylene implants showed deeper fibrovascular ingrowth than porous silicone sphere implants; 71.6% versus 63.6% (p = 0.102).ConclusionsPorous silicone orbital implants demonstrated a comparable extent of fibrovascular ingrowth to that for porous polyethylene implants. Therefore, this new porous silicone sphere implant may be a good candidate to substitute for current porous implants at a lower cost.

Surgical Outcomes of Intermittent Exotropia as a Function of Strabismic Angle

Purpose To analyze postoperative results of intermittent exotropia as a function of the difference in strabismic angles measured immediately and another time prior to the surgery. Methods We reviewed the clinical records of intermittent exotropia patients who received surgery and had differences greater than or equal to 10 prism diopters (PD) between the last preoperative measurement of strabismic angle and another previous measurement. After applying various exclusion criteria, 66 patients were entered into our study. At the last follow-up visit after surgery, we divided postoperative results into 3 categories: (1) poor; with greater than 10 PD of esotropia or angle of exodeviation of 20 PD or more (2) moderate; with 6-10 PD of esophoria/tropia or 10-19 PD exodeviation, or (3) good; with 1-5 PD of esophoria / tropia or an angle of exodeviation less than 10 PD, or orthophoria. Results Good results were higher in patients where the difference in strabismic angle was 10 PD or greater between the last measurement and any other earlier measurement. Conclusions In cases of Intermittent exotropia where the last preoperative value of strabismic angle was greater than any previous preoperative measurement, surgical dosage based on the last preoperative measurement yielded better results.

Amblyopia and Strabismus by Monocular Corneal Opacity Following Suspected Epidemic Keratoconjunctivitis in Infancy

Purpose To identify the long term clinical course of amblyopia and strabismus that developed secondary to a monocular corneal opacity following suspected epidemic keratoconjunctivitis (EKC) in infancy. Methods This was a retrospective study analyzing the medical records of seven patients, treated in our clinic, who were followed for more than five years. Results Four patients in our clinic underwent a corneal ulcer treatment following suspected EKC. Each developed a monocular corneal opacity. Three patients with a chief complaint of corneal opacity were transferred to our clinic from other clinics. These patients had documented histories of treatment for EKC in infancy. All patients were treated with early occlusion therapy, but amblyopia persisted in four patients. Furthermore, all patients had strabismus and showed a significant reduction of stereoscopic vision. Conclusions Although infants with EKC are not always cooperative, slit lamp examination should be performed as early as possible, and appropriate medical treatment should be performed, thus reducing the development of corneal opacity. Careful follow up should be regularly performed, and the occurrence of amblyopia or strabismus should be verified at an early stage using visual acuity or ocular alignment examination. Ophthalmologic treatments, including active occlusion therapy, should also be pursued.

Recurrent symptomatic intraocular pressure spikes during hemodialysis in a patient with unilateral anterior uveitis

BackgroundThe relationship between intraocular pressure (IOP) changes and hemodialysis has been evaluated for several decades. However, no report on an IOP rise in uveitis patients during hemodialysis has been previously documented. This report describes the case of an uveitis patient with repetitive IOP spikes associated with severe ocular pain during hemodialysis sessions, which resolved after glaucoma filtering surgery.Case presentationA 47-year-old male with diabetes and hypertension had complained of recurrent ocular pain in the left eye during hemodialysis sessions. A slit-lamp examination showed diffuse corneal epithelial edema with several white keratic precipitates and inflammatory cells (Grade 3+) in the anterior chamber of the left eye. No visible neovascularization or synechiae were visible on the iris or angle. Topical glaucoma eye-drops and intravenous mannitol before hemodialysis did not prevent subsequent painful IOP spikes in the left eye. At the end of hemodialysis, IOP averaged ~40 mmHg. After trabeculectomy with mitomycin C in the left eye, his IOP stabilized in the low-teens (range, 10–14 mmHg) and no painful IOP spikes occurred during hemodialysis over the first postoperative year.ConclusionWe present a case of recurrent painful IOP spikes during hemodialysis in a patient with unilateral anterior uveitis unresponsive to conventional medical treatment prior to hemodialysis. To our knowledge, this is the first case report of repetitive symptomatic IOP rise during hemodialysis in an uveitic glaucoma patient. This case highlights the importance of the awareness of the possibility that IOP may rise intolerably during hemodialysis in uveitis patients with a compromised outflow facility.

The association between intraocular pressure and different combination of metabolic syndrome components

BackgroundAlthough the association between metabolic syndrome and intraocular pressure is well known, the relationship between the intraocular pressure and different combination of the components of metabolic syndrome has not been actively researched yet. The study aimed to investigate the relationship between the intraocular pressure and metabolic syndrome components with their different combinations.MethodsThirty-one thousand two hundred seventy one healthy people aged 19–79 who attended a community hospital for a health check-up between January 2011 and December 2013 were enrolled in the study. Subjects with a history of intraocular disease, at least in one eye and those receiving medical treatment for glaucoma were excluded. Metabolic syndrome was diagnosed following the criteria defined in Circulation 2009.ResultsSubjects with combination of three metabolic syndrome components of triglycerides, abdominal obesity, and fasting glucose had the highest intraocular pressure. And subjects with the combination of four components of blood pressure, high-density lipoproteins, triglycerides, fasting glucose had a significantly higher intraocular pressure than ones with the combination of all five metabolic syndrome components.ConclusionsThe difference in the risk of high intraocular pressure according to the different combination of the metabolic syndrome components could be confirmed. If additional follow-up studies are conducted, the findings can be used as an indicator for predicting intraocular pressure increases in patients with metabolic syndrome.