Ken-Kuo Lin

Prognostic indicators of open globe injuries in children

PURPOSEnTo determine the prognostic indicators of visual outcome in children with open globe injuries.nnnBASIC PROCEDURESnThe charts of 62 patients, 16 years of age or younger, who had been treated for open globe injuries were reviewed.nnnMAIN FINDINGSnThe types of injury included penetrating (30 eyes), rupture (20 eyes), intraocular foreign body (10 eyes), and perforation (2 eyes). Sharp objects, such as knives or scissors, were the most common causes of open globe injuries. A visual acuity (VA) of at least 20/40 was achieved in 80.8% (21/26) of eyes with a corneal injury only, in 45.5% (5/11) of eyes with additional lens damage, and in 17.4% (4/23) of eyes with extensive anterior and posterior injuries.nnnCONCLUSIONSnUnfavorable outcomes were related to the location of injury, the extent of injury, the initial presentation of hyphema, vitreous hemorrhage, retina detachment, cornea wound across the pupil, and the development of endophthalmitis.

Intravitreal loading injection of ganciclovir with or without adjunctive oral valganciclovir for cytomegalovirus anterior uveitis

BackgroundA pilot study was conducted to evaluate the therapeutic results of intravitreal ganciclovir injection as a loading dose with or without the following oral valganciclovir for the treatment of cytomegalovirus (CMV) anterior uveitis in immunocompetent patients.MethodsSix consecutive patients in whom active CMV anterior uveitis was detected by polymerase chain reaction assay of the aqueous humor were enrolled between January 2006 and December 2008. These patients received an intravitreal injection of ganciclovir (2xa0mg/0.05xa0ml) as a loading dose. Subsequent use of oral valganciclovir (900xa0mg twice a day) was determined according to the severity of the post-injection aqueous inflammation. Immune status and anterior chamber reaction of individual patients, visual acuity, intraocular pressure (IOP) at study entry, and follow-up intervals were examined.ResultsThe mean patient-month follow-up period after intravitreal injection was 14.7xa0months (range, 12–22xa0months). Two patients received only the intravitreal ganciclovir injection once and four patients had received the following oral valganciclovir for average 2.3xa0months (range, 1–4xa0months). With this treatment strategy, the best-corrected visual acuity of the patients improved or stabilized; the IOP and the inflammation of anterior chamber of the patients were well controlled at all time points and there were no treatment-associated complications by the end of follow-up.ConclusionsIn patients with CMV anterior uveitis, intravitreal ganciclovir injection as a loading dose with or without the following oral valganciclovir can control the inflammation and IOP well.

The validity of clinical feature profiles for cytomegaloviral anterior segment infection

BackgroundAnterior segment cytomegalovirus (CMV) infection, which can be presented as anterior uveitis and corneal endotheliitis, has recently been reported in immunocompetent patients. We would like to access the validity of two presumed characteristic clinical profiles: profile 1, non-herpes simplex virus (HSV)/varicella zoster virus (VZV) corticosteroid-recalcitrant inflammatory ocular hypertensive syndrome (IOHS), and profile 2, corneal endotheliitis with specific coin-shaped keratic precipitates (KPs), that could be helpful in identifying CMV anterior segment intraocular infection.MethodsPatients with either profile 1 or profile 2 or both were enrolled consecutively from the uveitis service in Chang Gung Memorial Hospital, Taoyuan, between January 1, 2006 and May 31, 2010. Diagnostic anterior chamber tapping was performed and followed by real-time quantitative polymerase chain reaction (PCR) to detect herpesviridae DNA including HSV I and II, VZV, CMV, and Epstein–Barr virus.ResultsThirty-one eyes of 30 patients (21 males and nine females) were enrolled in this study. CMV DNA PCR was positive in 29 eyes of 28 patients (20 males and eight females). Nineteen of 20 eyes (19 patients) in profile 1 had positive CMV PCR. Ten of 11 eyes (11 patients) in profile 2 had positive CMV PCR. The positive predictive value of profile 1 and profile 2 was 94.7% and 90.9%, respectively. The positive predictive value of combining the two profiles was 93.3%.ConclusionsNon-HSV/ZVZ corticosteroid-recalcitrant IOHS and corneal endotheliitis with specific coin-shaped KPs could be used as the screening tool for CMV anterior segment intraocular infection.

Clinical characteristics and surgical outcomes of pediatric cataract in Taiwan

PurposeTo report treatment of pediatric patients with cataract, and evaluate the efficiency of different surgical interventions.MethodThis study comprised a consecutive series of pediatric patients with congenital or developing cataract who received surgery between 1993 and 2002 at Chang Gung Memorial Hospital in Taiwan. Patients’ demographics, cataract type, presenting symptoms, surgical intervention, postoperative visual acuity, and follow-up refractive changes were recorded.ResultsThree hundred and ninety-nine eyes of 246 children were included; unilateral cataract was present 21.8% of the eyes. The age at surgery was ranged from 1 to 157 months. Eyes were grouped by surgical interventions performed: Group 1 included 98 eyes that had lensectomy. Group 2 included 89 eyes that had lensectomy and secondary intraocular lens implantation. Group 3 included 212 eyes that had lensectomy with primary intraocular implantation. The mean follow up time was 41.3xa0months. Finally, 23.1% group 1 patients, 42.1% group 2 patients, and 63.4% group 3 patients achieved visual acuity better than 20/60 (P=0.000). Upon analysis with multifactor regression, age at onset (P=0.011) was the only significant factor related to visual outcome. Complications such as after cataract and glaucoma occurred in 21.6% and 5.8% of all patients, respectively.ConclusionsIntraocular lens implantation for children with congenital or developing cataract is an effective treatment for visual rehabilitation, even for those patients age 2xa0years and younger.

Neonatal lupus complicated by hemorrhagic stroke

Neonatal lupus is a passively acquired autoimmune syndrome resulting from the transplacental passage of maternal anti-Ro/SSA and/or anti-La/SSB antibodies to the fetus. Few past studies have reported central nervous system involvement in neonatal lupus, and most cases had a good neurological outcome. We report here a preterm case of neonatal lupus with thrombocytopenia and comorbid hemorrhagic stroke. In the follow-up, the infant developed spastic quadriplegia and showed delayed milestones. We believe that this is the first reported case of neonatal lupus accompanied by perinatal hemorrhagic stroke. We present this case to remind clinicians to conduct regular central nervous system surveys in cases of neonatal lupus.

Down-Regulation of Matrix Metalloproteinase-9 by Pyrrolidine Dithiocarbamate Prevented Retinal Ganglion Cell Death After Transection of Optic Nerve in Rats

Purpose: To investigate the effects of pyrrolidine dithiocarbamate (PDTC), a nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB) inhibitor, on the expression of matrix metalloproteinases (MMP) and MMP-mediated apoptosis in retinal ganglion cells (RGCs) following the transection of the optic nerve (ON) in rats. Materials and Methods: The ON of adult male Sprague-Dawley rats was transected. The expression of MMP-2, MMP-9, and NF-κB was measured by Western blot analysis and immunohistochemical analysis following transection. In situ zymography was also performed to localize gelatinolytic activity in the retinas. PDTC was injected intravitreally immediately following transection of the ON to evaluate the effect on the expression of NF-κB and MMP as well as its anti-apoptotic effect and neuroprotective effect on RGCs. Results: Significant up-regulation of MMP-9, and NF-κB was observed 7 days post-transection; however, this was not observed for MMP-2. PDTC at concentrations of 0.5u2009mM suppressed the up-regulation of MMP-9 and NF-κB, inhibiting gelatinolytic activity in the RGC layer. Meanwhile, far fewer apoptotic RGCs were detected and more surviving RGCs were preserved in PDTC-treated retinas 7 days post-transection compared to retinas in the control group. However, this kind of neuroprotective effect was not significant at 14 days post-transection. Conclusions: This study demonstrated that PDTC, mediated in part through the down-regulation of MMP-9, could contribute to delaying the death of RGCs following transection of the ON.

Iron Foreign Body in the Optic Nerve without Ocular Siderosis.

An intraocular iron foreign body may cause many ocular complications, sometimes even blindness. Therefore, if possible, it should be removed to avoid ocular siderosis. We report a case in which a foreign body was trapped in the optic nerve and could not be removed. After a 2‐year follow‐up, no ocular siderosis or progressive deterioration in vision was found. This is the first case report of a foreign body in the optic nerve behind the eyeball in the PubMed literature.

Correction of hyperopia with astigmatism following radial keratotomy with daily disposable plus spherical contact lens: a case report

PurposeTo report the refractive correction in a case of hyperopia and astigmatism following radial keratotomy.MethodsA case report.ResultsA 47-year-old woman, who had undergone refractive surgery for radial keratotomy in both eyes 22xa0years before the present study, presented to our clinic with blurred vision. Her best corrected visual acuity, with spectacle correction of +3.50 DS/−1.50 DCX130° in the right eye and +3.75 DS/−1.50 DCX80° in the left eye, was 0.2 logMAR and 0.3 logMAR, respectively. Her keratometric readings were 35.75 D/36.75 D at 74° and 35.25 D/36.25 D at 61°, respectively. Prompted by intolerance to glasses, the patient requested for contact lenses. First, we applied a rigid, gas-permeable contact lens. However, we noted poor fitting due to central corneal flattening. Subsequently, we applied a conventional plus spherical soft contact lens (PSSCL), which is thick in the center and can therefore correct hyperopia and low-grade astigmatism simultaneously. The conventional PSSCL showed slightly inferior decentration, with good movement, and the patient was satisfied with it. After ascertaining the patient’s living habits, we decided that a daily disposable soft contact lens would most meet her needs. The final prescription was a daily disposable PSSCL; the patient was satisfied with her corrected visual acuity of 0.0 logMAR in the right eye and 0.0 logMAR in left eye. Her daily disposable PSSCL-corrected visual acuity was stable during the 10-month follow-up.ConclusionFor patients displaying hyperopia with astigmatism following radial keratotomy, the PSSCL may confer better corrected visual acuity and acceptability.

Factors affecting surgical outcome of intermittent exotropia

PURPOSE: The purpose of this study was to investigate the factors affecting surgical outcome in intermittent exotropia. DESIGNS: This was a retrospective interventional study. METHODS: Intermittent exotropic patients who had undergone surgical correction with a postoperative follow-up period of 1 month or more were included in the study. Surgical success was defined as an alignment between 10 prism diopters (PD) of exotropia or 5 PD of esotropia at 1 month. After data collection, data were analyzed in SPSS version 23 software. The main outcome measures were the factors affecting surgical outcome. RESULTS: We included 101 patients, including 52 (51.5%) male and 49 (48.5%) female. Among them, 62 (61.4%) patients achieved surgical success. Undercorrection was the primary reason of surgical failure. Multivariate regression analysis showed that a larger preoperative angle of deviation was associated with unfavorable surgical outcome (P = 0.053, odds ratio [OR] =0.97, 95% confidence interval [CI] = 0.94–1.00), and the presence of postoperative day 1 (POD 1) diplopia correlated significantly with higher surgical success (P = 0.001, OR = 4.54, 95% CI = 1.80–11.43). The presence of POD 1 diplopia was highly associated with POD 1 esotropia (P = 0.005, OR = 7.26, 95% CI = 1.84–28.58). CONCLUSION: In intermittent exotropia, larger preoperative angle of deviation may predict a lower surgical success rate. Despite a worrisome issue, the presence of diplopia on first POD is associated with immediate postoperative alignment of esotropia and predicts a higher surgical success.

Time trends in cataract surgery and after-cataract laser capsulotomy in Taiwan: A population-based retrospective cohort study

OBJECTIVESnDetermine the incidence rate, risk factors, and time trends from 2000 to 2010 for cataract surgery and after-cataract laser capsulotomy.nnnMATERIALS AND METHODSnLongitudinal Health Insurance Databases (LHID) with approximately 3 million people in Taiwan National Health Insurance Program from 2000, 2005, and 2010 was used. Index year was defined as year 2000 for LHID2000, year 2005 for LHID2005, and year 2010 for LHID2010.nnnRESULTSnThe age-standardized rate of first-eye cataract surgery per 100,000 persons was 324 (95% confidence interval [CI]xa0=xa0288-363) in 2000, 317 (95%CIxa0=xa0288-353) in 2005, and 342 (95%CIxa0=xa0308-379) in 2010. Risk factors related to the incidence of cataract surgery included age, sex, diabetes mellitus, geographic region, and income level (all p valuesxa0<xa00.05). The incidence rate of laser posterior capsulotomy within 2 years after cataract surgery was 23.3% in 2000 but decreased to 14.6% in 2005 and to 12.9% in 2010. The incidence of laser capsulotomy for after-cataract was significantly associated with index year, age, sex, in- or out-patient, and edge design of intraocular lenses (all p valuesxa0<xa00.05).nnnCONCLUSIONnThe incidence rate of cataract surgery over year 2000-2010 remained stable after age standardization. However, the incidence rate of laser capsulotomy for after-cataract significantly decreased during the 10-year study period.