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  Citation statistics : Table of Contents
   2015| October-December  | Volume 5 | Issue 4  
    Online since April 12, 2017

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Prevalence of general binocular dysfunctions among rural schoolchildren in South Korea
Jung Un Jang, Inn-Jee Park
October-December 2015, 5(4):177-181
DOI:10.1016/j.tjo.2015.07.005  PMID:29018694
Background/Purpose: To assess the prevalence of nonstrabismic accommodative and vergence dysfunc tions among primary schoolchildren in Hampyeong, a rural area of South Korea. Methods: Five hundred and eighty-nine primary schoolchildren, 8–13 years old, were each given a thorough eye examination, including binocular-vision testing, near point of convergence, horizontal phoria measurement by von Graefe, and negative and positive vergence amplitudes with prism bar, to determine any form of accommodative or vergence dysfunctions. Results: Of the 589 participants examined, 168 (28.5%) primary schoolchildren presented some form of nonstrabismic accommodative or vergence dysfunctions. The prevalence of accommodative dysfunctions and vergence dysfunctions was 13.2% and 9%, respectively. Convergence insufficiency (10.3%) was more prevalent than convergence excess (1.9%), and accommodative insufficiency (5.3%) was more prevalent than accommodative excess (1.2%). Conclusion: This study suggests that nonstrabismic accommodative and vergence dysfunctions are prevalent in the rural area of South Korean primary schoolchildren, and convergence insufficiency was the most prevalent.
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Immunosuppressive therapy for eye diseases: Effectiveness, safety, side effects and their prevention
Dana M Hornbeak, Jennifer E Thorne
October-December 2015, 5(4):156-163
DOI:10.1016/j.tjo.2015.03.004  PMID:29018691
Ocular inflammation is a significant cause of ocular morbidity and visual impairment. Topical, periocular, intraocular, and systemic corticosteroids are highly effective for treating appropriate forms of ocular inflammation. However, their use may be constrained by local and/or systemic side effects, especially if long-term therapy is required. As a result, immunosuppressive agents increasingly have been used to manage ocular inflammation alongside or in place of corticosteroids. The four categories of agents used today are antimetabolites [primarily methotrexate, mycophenolate mofetil (MMF), and azathioprine]; T-cell inhibitors (usually cyclosporine, less often tacrolimus or sirolimus); alkylating agents (cyclophos-phamide and chlorambucil); and biologic agents [tumor necrosis factor (TNF) inhibitors, lymphocyte inhibitors, and interleukin inhibitors]. The primary goals of immunosuppressive therapy are (1) to control inflammation when corticosteroids fail to do so; (2) to prevent corticosteroid-induced toxicity when the necessary corticosteroid dosage exceeds the desired or safe level (corticosteroid sparing); and (3) to treat specific high-risk uveitis syndromes known to respond poorly to corticosteroids alone. Growing evidence shows the effectiveness of immunosuppressive drugs in achieving these goals, as well as improved visual function, prevention of ocular complications, and in some cases even disease remission. However, these agents also have side effects, which must be considered in each patient's management. In this report, we summarize the effectiveness and safety of immunosuppressive drug therapy utilized in the treatment of ocular inflammatory diseases.
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Axial length and subfoveal choroidal thickness in individuals with age-related macular degeneration
Chih-Ping Wang, Chien-Hsiung Lai, Evelyn Jou-Chen Huang, Pei-Lun Wu, Ching-Lung Chen, Chau-Yin Chen, Yin-Chi King, Pei-Chen Wu, Chien-Neng Kuo
October-December 2015, 5(4):169-176
DOI:10.1016/j.tjo.2015.10.002  PMID:29018693
Purpose: To compare axial length (AL) and subfoveal choroidal thickness (SFCT) between individuals with age-related macular degeneration (AMD) and controls with no lesions. Methods: This was a case-control study. In total, 853 eyes of 484 patients (>65 years), including 397 eyes at various AMD stages and 456 eyes with no fundus lesions (controls) were recruited. Using color fundus photography, eyes were grouped according to AMD degree. AL was automatically measured using IOL Master and SFCT was manually measured by two independent observers. The associations among age, AL, SFCT, and each AMD grade were analyzed. Results: Out of 853 eyes, 456 had no lesions, 217 contained drusen only, 134 had early AMD, and 46 had late AMD. The eyes with late AMD were older (p = 0.007) and had longer AL (p ≥ 0.001) and thinner SFCT (p < 0.001) compared with groups of no fundus lesions, drusen only, and early AMD. SFCT in eyes with late AMD decreased by 19.20 μm (p = 0.049), 24.78 μm (p = 0.029), and 15.56 μm (p = 0.162) compared with groups of no fundus lesions, drusen only, and early AMD, respectively. SFCT decreased by 14.18 μm/ mm increase in AL (p < 0.001). The odds ratio (OR) for late AMD by longer AL (≥25 mm) and thinner SFCT (<240 μm) was 4.54 (χ2 = 9.36; p = 0.002) and 4.86 (χ2 = 17.62; p < 0.001), respectively, and was 9.57 (χ2 = 18.07; p < 0.001) when both AL ≥ 25 ≥m and SFCT < 240 μm. Conclusion: Eyes with late AMD have distinct reduced SFCT and elongated AL. Eyes with thinner SFCT and longer AL showed high ORs for late AMD and even higher ORs when both factors were simultaneously present. These findings illustrate the crucial pathophysiological role of these two important ocular fac tors and arouse our attention to patients with both characteristics, especially in Asian countries where the prevalence of myopia are disturbingly high.
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Sub-internal limiting membrane hemorrhage treated with intravitreal tissue plasminogen activator followed by octafluoropropane gas injection
Yu-Kang Chou, Yi-Ming Huang, Po-Kang Lin
October-December 2015, 5(4):198-201
DOI:10.1016/j.tjo.2014.10.006  PMID:29018700
Sub-internal limiting membrane (sub-ILM) hemorrhage is a relatively rare disease which is associated with different etiologies and often leads to loss of visual acuity. We report two cases of sub-ILM hemorrhage, both confirmed by optical coherence tomography (OCT) and treated with an intravitreal injection of tissue plasminogen activator (tPA) followed by an octafluoropropane (C3F8) pneumopexy and a strict postoperative prone positioning. The hemorrhage was totally resolved and complete visual recovery was achieved in both cases. We found tPA hemolysis with C3F8 pneumopexy to be a safe and effective method for treating sub-ILM hemorrhage.
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When is macular edema not macular edema? An update on macular telangiectasia type 2☆
Lihteh Wu
October-December 2015, 5(4):149-155
DOI:10.1016/j.tjo.2015.09.001  PMID:29018690
Macular telangiectasia type 2 (Mac Tel 2) also known as idiopathic perifoveal telangiectasia and juxta-foveolar retinal telangiectasis type 2A is an enigmatic disease of unknown etiology. It manifests both neurodegenerative and vasculopathic characteristics. It manifests itself during the fifth or sixth decades of life. Clinical characteristics include minimally dilated parafoveal capillaries with loss of the retinal transparency in the area involved, absence of lipid exudation, right-angled retinal venules, superficial retinal refractile deposits, hyperplasia of the retinal pigment epithelium (RPE), foveal atrophy and subretinal neovascularization (SRNV). Optical coherence tomography (OCT) images typically demonstrate outer retinal abnormalities and the presence of intra-retinal hyporeflective spaces that are usually not related with retinal thickening or fluorescein leakage. The typical fluorescein angiographic finding is a deep intraretinal hyperfluorescent staining in the temporal parafoveal area. With time this fluorescein hyperfluorescence involves the whole parafoveal area but does not extend to the center of the fovea. Long-term prognosis for central vision is poor, because of the development of SRNV or macular atrophy. Its pathogenesis remains unclear but multi-modality imaging with fluorescein angiography, spectral domain OCT, adaptive optics, confocal blue reflectance, short wave fundus autofluorescence, OCT angiography, and clinicopathological correlations implicate Muller cells. Currently there is no known treatment for this condition.
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Negative Mantoux test in a patient with definite pulmonary and ocular tuberculosis
Chen-Cheng Chao, Chun-Ju Lin, Huan-Sheng Chen, Tsung-Lin Lee
October-December 2015, 5(4):182-186
DOI:10.1016/j.tjo.2014.08.002  PMID:29018695
The case is reported of a patient with pulmonary and ocular tuberculosis presenting with blurred vision in both eyes. A 27-year-old well-nourished male nursing-home resident with a previous history of traumatic intracerebral hemorrhage was brought to the ophthalmological clinic due to progressively blurred vision. His best-corrected visual acuity was 20/400 in the right eye with only light perception in the left eye. Fundus examinations revealed retinal segmental periphlebitis and hemorrhagic retinitis in the right eye and dense vitreous hemorrhage in the left eye. The Mantoux test was negative; however, the results of an interferon gamma release assay were positive. Ocular tuberculosis was suspected. Although he had never had any respiratory symptoms, his chest radiograph and computed tomography scan showed a multiple centrilobular glandular and ground-glass appearance with air-space consoli dations and atelectasis in both lower lobes. Pulmonary tuberculosis was confirmed by a positive acid-fast stain of a bronchial alveolar lavage sample. A GEN-PROBE amplified Mycobacterium tuberculosis direct test of the vitreous fluids was also positive. Ocular tuberculosis was confirmed. After treatment for tuberculosis and vitrectomies, his final best-corrected visual acuity improved to 20/30 in the right eye and 20/200 in the left eye. Ocular tuberculosis is rarely reported as the primary presentation of systemic tuberculosis in young patients. A negative Mantoux test may lead to misdiagnosis and delayed treatment. Doctors should become more familiar with the manifestations of systemic tuberculosis and use advanced diagnostic tools in cases of clinical suspicion.
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Varicella zoster virus-associated neuroretinitis
Wei-Shan Tsao, Ming-Shan He, Rong-Kung Tsai
October-December 2015, 5(4):189-191
DOI:10.1016/j.tjo.2014.10.001  PMID:29018697
Varicella zoster virus-associated neuroretinitis is rare. We report a patient who presented with blurred vision of the left eye and extraocular movement pain. A fundoscopic examination revealed disc edema, hyperemia, and macular edema. The impression was neuroretinitis. Intravenous methylprednisolone pulse therapy was administered. However, visual recovery was incomplete with optical coherence to mography (OCT) imaging showing photoreceptor layer disruption. The laboratory data were rechecked and demonstrated a high varicella zoster virus immunoglobulin G titer. Varicella zoster virus-associated neuroretinitis was suspected and oral acyclovir was prescribed. His visual acuity improved to 0.9 after 2 weeks of treatment, and OCT showed photoreceptor layer restoration. Spectrum-domain OCT provides useful information when evaluating the disease course of neuroretinitis.
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Rapid anterior capsular phimosis after cataract surgery in a patient with chronic angle closure glaucoma
Pei-Yao Chang, Shu-Wen Chang
October-December 2015, 5(4):192-194
DOI:10.1016/j.tjo.2014.10.003  PMID:29018698
We report a case of complete occlusion of capsulorrhexis opening in a patient with chronic angle closure glaucoma with fixed–dilated pupil in the following 2 weeks after an uneventful cataract surgery. The capsulorrhexis diameter was intended to make between 5.0 mm and 5.5 mm, to prevent photophobia afterward. There was no evidence of zonular weakness on preoperative examination or during the surgery. Nd:YAG anterior capsulotomy was performed for capsular phimosis and to enlarge capsulor-rhexis. The patient regained her visual acuity 3 days after laser treatment, and no pseudophakodonesis, intraocular lens decentration, and re-phimosis were noted at the 3-month follow-up.
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Ocular decompression retinopathy after laser iridotomy in a patient with acute angle closure
Tzu-Te Hu, Shao-Chun Chen, Po-Chen Tseng, Chun-Chen Chen, Shiow-Wen Liou
October-December 2015, 5(4):195-197
DOI:10.1016/j.tjo.2014.10.005  PMID:29018699
A 65-year-old female developed elevated intraocular pressure (IOP) with angle closure in the right eye. The fundus examination revealed vitreo-retinal hemorrhage that had occurred after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser iridotomy. The retinal hemorrhage resolved spontaneously. This is a rare complication that occurs when the IOP is lowered rapidly. Ocular decompression reti-nopathy (ODR) was identified. We reviewed several cases of ODR that were treated by various interventions. We also discuss the possible pathogenesis, prognosis, and treatment strategy.
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Bilateral uveitis associated with concurrent administration of rifabutin and nelfinavir
Wen-Hsin Cheng, Cheng-Hsien Chang, Po-Liang Lu, Hsien-Chung Lin
October-December 2015, 5(4):187-188
DOI:10.1016/j.tjo.2014.08.004  PMID:29018696
Rifabutin-associated uveitis has been recognized as a dosage-dependent side effect. Previous studies have reported that clarithromycin or fluconazole may elevate concentrations of rifabutin through inhi bition of metabolism through the cytochrome P-450 pathway. Nelfinavir is a protease inhibitor widely used in the treatment of human immunodeficiency virus (HIV) infection. The interactions between protease inhibitors and rifabutin have not been reported in clinical practice. Therefore, we present a case of bilateral uveitis associated with coadministration of rifabutin and nelfinavir. Uveitis did not subside until discontinuation of rifabutin. To our knowledge, this is the first report of uveitis with concurrent administration of rifabutin and nelfinavir. Our finding reminds us that rifabutin dosage should be reduced when it is administered with protease inhibitors.
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Choose the right treatment for the right patients
Shwu-Jiuan Sheu
October-December 2015, 5(4):147-148
DOI:10.1016/j.tjo.2015.10.001  PMID:29018689
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Refractive error, visual acuity, and corneal-curvature changes in high and low myopes with orthokeratology treatment: A Malaysian study
Swee Lee Liong, Norhani Mohidin, Bay Wah Tan, Bariah Mohd Ali
October-December 2015, 5(4):164-168
DOI:10.1016/j.tjo.2015.07.006  PMID:29018692
Background/Purpose: The effect of orthokeratology (OK) on low myopia is well known, but there are a few reports on its effect on high myopia. In this study, the parametric changes in high and low myopia as results of wearing OK lenses for a period of 6 months have been analyzed. Methods: Records of schoolchildren (age 7–17 years) undergoing OK treatment from an optometry clinic were retrospectively reviewed. Data involving refractive errors, uncorrected visual acuity, and corneal curvatures at baseline and after 1 day, 1 week, 1 month, 3 months, and 6 months of OK treatment from 25 patients who fulfilled the inclusion criteria were examined. For the analysis, the participants were arbitrarily divided into two groups comprising high myopia (< −6.00 D) and low to moderate myopia (from −1.00 D to −6.00 D). Results: Significant reductions of refractive error, improvement in visual acuity, and corneal-curvature flattening were found in all participants after 6 months of OK lens wear compared to the baseline. No significant changes were found in corneal toricity in both high and low to moderate myopic groups. Almost all of these occurred after one night of lens wear in both the high- and low-myopia groups. Conclusion: The OK lens wear significantly reduced the refractive error and corneal curvature that results in the improvement in visual acuity in both high- and low-myopia groups, and the reduction seemed to occur nearly at the same time despite the difference in initial myopic power. High myopes with refractive power up to −8.25 D would benefit significantly from OK lenses.
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