Seong-Joon Kim

Spectral-domain optical coherence tomography analysis in deprivational amblyopia: a pilot study with unilateral pediatric cataract patients

BackgroundTo investigate whether macular and peripapillary retinal nerve fiber layer (RNFL) structure differs among deprivational amblyopic eyes, fellow non-amblyopic eyes, and age-matched normal eyes, using spectral-domain optical coherence tomography (SD-OCT).MethodsMacula and optic disc of 14 unilateral pseudophakic children with deprivational amblyopia, and 14 age-matched normal children (mean age, 7.45u2009±u20092.57xa0years) were scanned with CirrusTM HD-OCT. Macular, RNFL, and macular ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured, and compared between the eyes after correction for axial length-related magnification errors.ResultsThe average RNFL thickness tended to be greater in amblyopic eyes (99.64u2009±u200910.11xa0μm) than in fellow non-amblyopic eyes (97.28u2009±u200912.34xa0μm) and normal eyes (95.38u2009±u20099.74xa0μm), but did not show statistical significance (pu2009=u20090.429, pu2009=u20090.286 respectively). The nasal RNFL thickness was significantly greater in amblyopic eyes (75.84u2009±u200919.22xa0μm) than in fellow non-amblyopic eyes (63.42u2009±u200914.05xa0μm, pu2009=u20090.037) and normal eyes (62.38u2009±u20099.65xa0μm, pu2009=u20090.043). The central macular thickness in amblyopic eyes (237.05u2009±u200937.74xa0μm) showed no significant differences compared to those of fellow non-amblyopic eyes (226.67u2009±u200934.71xa0μm) and normal eyes (233.74u2009±u200927.11xa0μm) (pu2009=u20090.137, pu2009=u20090.792 respectively). The macular GCIPL thickness showed no significant difference among the amblyopic, fellow non-amblyopic, and normal eyes (average; 78.94u2009±u20096.35xa0μm vs 78.77u2009±u20096.43xa0μm vs 82.22u2009±u20095.00xa0μm respectively, pu2009>u20090.05).ConclusionsSD-OCT analysis of deprivational amblyopic eyes with unilateral pediatric cataract demonstrated significant increase in nasal RNFL thickness compared to fellow non-amblyopic eyes and age-matched normal eyes. The macular and macular GCIPL thickness did not show any significant difference. Taken together, monocular pattern deprivation in early childhood may have changed the nasal peripapillary RNFL structure.

Long-term visual outcomes of penetrating keratoplasty for Peters anomaly

BackgroundTo investigate the long-term results and visual outcomes of penetrating keratoplasty (PKP) in Peters anomaly.MethodsTwenty-three eyes from 22 patients with Peters anomaly who underwent PKP from 1998 to 2008 were reviewed retrospectively. Patients who were followed for more than 3xa0years after the first PKP were included in this study. The systemic and ophthalmic features of the recipients were assessed, and the various prognostic factors for graft survival were evaluated. Disease severity was determined according to other accompanying eye anomalies in mild or severe form. The final visual outcomes were presented with respect to graft clarity.ResultsAmong the 22 patients, 14 patients had unilateral disease, and eight patients had bilateral disease. Associated systemic anomalies were observed in six patients. The mean age at the first PKP was 42.4xa0months. Nineteen eyes (83xa0%) underwent PKP after 12xa0months of age. The graft failure rates at 1xa0year, 3xa0years, 5xa0years, and 10xa0years after PKP were 30xa0%, 39xa0%, 70xa0%, and 77xa0% respectively. Graft rejection within 1xa0month after PKP and severe disease were significant risk factors for graft failure. The mean final VAs in the clear-graft group and the failed-graft group were 1.883 logMAR and 2.767 logMAR (Pu2009<u20090.001).ConclusionThe results of delayed PKP in Peters anomaly were not inferior compared to the results of PKP performed at an earlier period in previous studies. If other congenital ophthalmic anomalies were present or graft rejection occurred within 1xa0month after PKP, the chance of graft failure was significantly increased.

The Clinical Outcomes of Proton Beam Radiation Therapy for Retinoblastomas That Were Resistant to Chemotherapy and Focal Treatment

Purpose To evaluate the clinical results of proton beam radiation therapy (PBRT) for treatment of retinoblastoma. Methods Children with retinoblastoma who were treated with chemotherapy and focal treatment such as brachytherapy and thermotherapy but showed no response or developed recurrences later received PBRT. The PBRT strategy was designed to concentrate the radiation energy to the retinoblastoma and spare the surrounding healthy tissue or organs. Results There were three patients who received PBRT. The first patient received PBRT because of an initial lack of tumor regression with chemotherapy and brachytherapy. This patient showed regression after PBRT. The second patient who developed recurrence of retinoblastoma as diffuse infiltrating subretinal seeding was taken PBRT. After complete regression, there was recurrence of tumor and the eye was enucleated. The third patient had unilateral extensively advanced retinoblastoma. Initial chemotherapy failed and tumor recurred. The tumor responded to PBRT and regressed significantly. However, the eye developed sudden multiple recurrences, so we had to perform enucleation. Conclusions PBRT for retinoblastoma was effective in cases of showing no response to other treatment modalities. However, it should be carefully applied when there was recurrence of diffuse infiltrating subretinal seeding or extensively advanced retinoblastoma initially.

Visual Prognosis of Retinoblastoma in the Posterior Pole Treated with Primary Chemotherapy Plus Local Treatments

Purpose To evaluate the visual outcomes of retinoblastoma in the posterior pole (RBPP) treated with chemotherapy plus local treatments and to address the prognostic factors that influence such outcomes. Methods The medical records of patients with RBPP diagnosed at the Department of Pediatric Ophthalmology, Seoul National University Childrens Hospital between August 1987 and September 2007 were reviewed retrospectively. Only those patients treated via primary chemotherapy plus local treatments were included. The presence of foveal involvement and tumors in the posterior pole before and after treatment, the type of regression pattern and the best corrected visual acuity (BCVA) of each patient were evaluated. Results A total of 13 eyes in 12 patients were included. The mean final BCVA for treated RBPP was 20/210 (range, hand motion to 20/16). However, eight eyes (61.5%) had an acuity of 20/200 or better and seven eyes (53.8%) had an acuity of 20/50 or better. The mean final BCVA was significantly better in cases with negative foveal involvement; however, four eyes (37.5%) with positive foveal involvement had an acuity of 20/200 or better. Tumors area in the posterior pole and the type of regression pattern were not significantly related to final BCVA. Conclusions Over one half of the studied RBPP patients had working vision. Although the eyes had RBPP with positive foveal involvement, about one-third of the patients had working vision. Vision preservation should be considered when deciding on RBPP treatment.

Congenital aniridia: long-term clinical course, visual outcome, and prognostic factors.

Purpose To describe the clinical course of congenital aniridia and to evaluate prognostic factors for visual outcome after long-term follow-up. Methods The medical records of 120 eyes from 60 patients with congenital aniridia were retrospectively reviewed. The prevalence and clinical course of ophthalmic characteristics, systemic disease, refractive errors, and visual acuity were assessed. Prognostic factors for final visual outcomes were analyzed. Results Aniridic keratopathy developed in 82 (69%) of 119 eyes. Macular hypoplasia was observed in 70 eyes of 35 patients (91%). Cataract was observed in 63 of 120 eyes (53%). Nystagmus was present in 41 patients (68% of 60 patients) at the initial visit but decreased in five patients (8% of 60 patients). Ocular hypertension was detected in 19 eyes (20% of 93 eyes), six (32% of 19 eyes) of which developed secondarily after cataract surgery. The mean changes in spherical equivalent and astigmatism during the follow-up period were -1.10 and 1.53 diopter, respectively. The mean final visual acuity was 1.028 logarithm of minimal angle of resolution. Nystagmus and ocular hypertension were identified as prognostic factors for poor visual outcome. Conclusions Identification of nystagmus and ocular hypertension was important to predict final visual outcome. Based on the high rate of secondary ocular hypertension after cataract surgery, careful management is needed.

Prognostic factors for visual recovery after transsphenoidal pituitary adenectomy

Abstract Objectives. Pituitary adenomas often cause deficits in visual acuity (VA) and visual field (VF) due to compression of the optic chiasm. This study is to identify factors most likely to predict the prognosis of VA and VF after transsphenoidal pituitary adenectomy. Materials and methods. Clinical records of patients who underwent transsphenoidal pituitary adenectomy were retrospectively reviewed. Data analysed included systemic and visual symptom duration, tumour size, presence of suprasellar tumour extension, histological classification of tumour, VA, and VF. VFs were determined using the Goldmann VF test and quantified according to methods outlined by the American Medical Association. Results. One-hundred and seventy eyes from 85 patients were included. Systemic and visual symptom duration, pre- and postoperative tumour size, and age did not correlate with postoperative VA or VF score. Patients with normal preoperative VA had a better postoperative VA than that of patients with preoperative VA of 20/30 or worse. Patients with normal preoperative VA had better postoperative VF score than that of patients with preoperative VA of 20/70 or worse. Postoperative VF score was lower in the preoperative ≥ 2 quadrant field loss group than in the ≤ 1 quadrant field loss group. Postoperative VA was worse in the ≥ 2 quadrant loss group than in the normal field group. Preoperative VA correlated with postoperative VA and VF score, and preoperative VF score correlated with postoperative VF score but not with VA. Conclusions. Preoperative VA is a prognostic factor for postoperative VA and VF. Preoperative VF is predictive of postoperative VF and postoperative VA in cases with severe VF loss.

Cataract surgery in children with and without retinopathy of prematurity

Purpose: To report the outcomes of cataract surgery in children born prematurely who had or did not have retinopathy of prematurity (ROP). Setting: Seoul National University Hospital, Department of Ophthalmology, Seoul, Korea. Methods: Retrospective studies were conducted by reviewing the charts of 26 eyes of 14 premature infants with or without ROP that had cataract surgery. The patients preoperative characteristics and postoperative visual outcomes were documented. Cataract surgery consisted of lensectomy, posterior capsulectomy, and anterior vitrectomy in patients younger than 2 years and primary posterior chamber intraocular lens (PC IOL) implantation or secondary PC IOL implantation in those 2 years or older. Postoperative optical correction in those younger than 2 years was by glasses or contact lenses. Results: Eight eyes of 5 patients had acute ROP; 4 eyes had stage 3, 2 had stage 2, and 2 had stage 1. Three eyes had transconjunctival cryotherapy for treatment of threshold ROP. First‐eye cataract surgery were performed in children from 0.2 to 5.5 years old (mean 1.5 years) and second‐eye surgery, in children from 1.8 to 12.1 years old (mean 4.3 years). Twenty eyes had implantation of a PC IOL. In 1 patient with stage 3+ ROP, Rush (plus) type, both eyes had combined cataract and scleral buckle encircling surgery. The mean follow‐up after the last surgery was 1.4 years (0.5 to 3.1 years). At the last examination, the best corrected visual acuity was good fixation or better than 20/80 except in 2 eyes, 1 with esotropia and the other with a dense pupillary membrane. Conclusions: This is the first report of an encouraging surgical outcome for PC IOL implantation in premature infants with cataract regardless of the presence of ROP. However, if retinopathy is present and has progressed in the cataractous eye of a premature child, careful examination and timely surgical decisions are important.

IIH with normal CSF pressures

Idiopathic intracranial hypertension (IIH) is a condition of raised intracranial pressure (ICP) in the absence of space occupying lesions. ICP is usually measured by lumbar puncture and a cerebrospinal fluid (CSF) pressure above 250 mm H2O is one of the diagnostic criteria of IIH. Recently, we have encountered two patients who complained of headaches and exhibited disc swelling without an increased ICP. We prescribed acetazolamide and followed both patients frequently; because of the definite disc swelling with IIH related symptoms. Symptoms and signs resolved in both patients after they started taking acetazolamide. It is generally known that an elevated ICP, as measured by lumbar puncture, is the most important diagnostic sign of IIH. However, these cases caution even when CSF pressure is within the normal range, that suspicion should be raised when a patient has papilledema with related symptoms, since untreated papilledema may cause progressive and irreversible visual loss.

Newly developed binocular treatment of amblyopia using head-mounted display

Amblyopia is defined as decrease of visual acuity in one eye when caused by abnormal binocular interaction or occurring in one or both eyes as a result of pattern vision deprivation during visual immaturity, for which no cause can be detected during the physical examination of the eye(s) and which in appropriate cases is reversible by therapeutic measures [1]. There are 2~5% of patients in population and the most common cause of visual impairment in children and monocular low vision in adults.

Orbital Apex Lesions: A Diagnostic and Therapeutic Challenge

Objective To analyze the clinical characteristics of and treatment outcomes for orbital apex lesions according to their pathological diagnosis and identify clinical characteristics that could aid in their differential diagnosis. Design Retrospective analysis design was used for this study. Setting The study was conducted in a single tertiary institution. Participants Patients with pathologically confirmed lesions centered in the orbital apex who were admitted between January 2011 and December 2015. Main Outcome Measures Clinical characteristics, including demographics, predisposing factors, presenting symptoms, radiological findings, intraoperative findings, biopsy results, and treatment outcomes. Results Nine patients with invasive fungal sinusitis, six with inflammatory pseudotumor, and six with neoplastic or tumorous lesions were enrolled. The most common presenting symptom was orbital pain or headache, followed by ophthalmoplegia and vision loss, which exhibited overall recovery rates of 62.5% and 33.3%, respectively, after definitive treatment. The prognosis was worse for patients with invasive fungal sinusitis. There was no significant difference in age, underlying medical conditions, absolute neutrophil count, C‐reactive protein level, and radiological findings among the three groups. Grossly necrotic tissues around the orbital apex area at biopsy were more frequently found in patients with invasive fungal sinusitis than in the other patients. In most cases, pain ameliorated after surgical intervention. There were no surgery‐related morbidities. Conclusions Lesions centered in the orbital apex included invasive fungal sinusitis, inflammatory pseudotumor, and tumorous lesions. However, clinical features that clearly differentiated chronic invasive fungal sinusitis from inflammatory pseudotumor could not be identified. Our findings suggest that prompt biopsy is warranted for timely diagnosis, symptom relief, and early implementation of definitive treatment.