Moon Sun Jung

Retinal hemorrhage associated with perinatal distress in newborns.

Purpose To describe the ophthalmoscopic features and natural history in a case series of eyes that developed intraocular hemorrhages associated with perinatal distress and to evaluate their clinical courses. Methods A retrospective chart review of 289 neonates with a medical history of perinatal distress was conducted. Among these 289 patients (578 eyes), 29 eyes of 17 neonates were found to have had retinal hemorrhages or vitreous hemorrhages (VH). A comprehensive chart review, including details of fundoscopic findings and perinatal history, was conducted. Results Intraocular hemorrhage was present in 5.5% of the patients. Most hemorrhages (82.7%) were intraretinal. In our population, 17% (n = 5) of hemorrhages resolved within two weeks, but 31% (n = 9) did not resolve even after four weeks. Most hemorrhages spontaneously resolved without any specific sequelae; however, one infants dense unilateral VH persisted up to three months after birth. When the patient was seen again at 3.5 years of age, she had developed axial myopia and severe amblyopia of the involved eye. Conclusions In asphyxiated newborns, the possibility of intraocular hemorrhages should be considered. Long-standing, dense hemorrhages obscuring the macula may lead to severe vision deprivation amblyopia. Therefore, ophthalmic examination should be considered in neonates with perinatal distress, and close observation is necessary for hemorrhages that do not resolve in this amblyogenic age group.

Metastatic esophageal squamous cell carcinoma to the orbit and periorbit masquerading as periorbital abscess.

A 61-year-old man with no history of malignancy presented with a rapidly expanding left periorbital mass, first noticed one month prior to presentation. The mass was firm, and a pus-like discharge drained spontaneously from the center of the lesion. A biopsy was performed, and histopathology confirmed squamous cell carcinoma. Systemic evaluation revealed that the patient had a primary esophageal squamous cell carcinoma with multiple metastases. The prognosis of orbital metastasis is generally poor, and this patient expired after one month of conservative treatment.

Changes in refractive error and anterior segment parameters after isolated lateral rectus muscle recession

PURPOSE To evaluate the short-term effect of isolated lateral rectus muscle recession surgery on refractive error, corneal measurements, and anterior chamber depth and volume. METHODS Consecutive patients who underwent isolated lateral rectus muscle recession from July 2008 to March 2009 were prospectively studied. Refractive error; corneal power, thickness, and volume; and anterior chamber depth and volume were measured (Pentacam) before and at 1 week and 1 month after surgery. Patients who could not maintain reliable fixation and those with sensory strabismus or a history of eye surgery were excluded. Pre- and postoperative measurements were compared by analysis of variance. RESULTS A total of 24 eyes of 24 patients (average age, 8 years) were included. Bilateral lateral rectus muscle recession was performed in 19 patients; unilateral in 5. Overall, patients manifested statistically significant changes in spherical equivalent, horizontal and mean keratometry, corneal astigmatism, anterior chamber volume, and center and peripheral anterior chamber depth at 1 week after surgery (P < 0.05). Changes became progressively smaller during the first month after surgery, although significant changes in spherical equivalent persisted at 1 month. CONCLUSIONS Lateral rectus muscle recession resulted in short-term changes in refractive error in this cohort. The etiology of the refractive change is unknown but could be due to alterations in muscle tension that affect corneal remodeling, segmental interruption of the ciliary body circulation affecting the lens curvature, postoperative tissue edema, and/or other postsurgical factors. The decrease in change after 1 month may be due to the effects of compensation by other quadrants of the eye or resolution of the surgical induced tissue damage. Longer follow-up is necessary to ascertain clinical significance.

Exotropia caused by pit viper snakebite.

Pit viper snake venom exerts a mildly neurotoxic effect that may rarely lead to neurotoxic complications, such as paralytic strabismus. Extraocular muscles are known to be particularly susceptible to this complication. In previously reported cases, the medial rectus muscle has been the most frequently involved. We report the first case of a pit viper snakebite resulting in comitant exotropia without obvious paralytic features.