Attention Deficit Hyperactivity in Exotropia Before and After Strabismus Surgery

Purpose: To evaluate the effect of strabismus surgery in exotropia patients suspected of attention deficit hyperactivity disorder (ADHD). Methods: Parents of 67 exotropia patients answered the Conner Teacher Rating Scale-Revised for suspecting ADHD before and after 3 months of surgery. Patients were divided into 2 groups by preoperative scale scores. Group 1 had scores under 15 and group 2 who were suspected to have ADHD had scores above 15. Characteristics of exotropia and scale score differences were evaluated. Results: Group 1 had 43 patients and group 2 had 24 patients. The ratio of group 2 was significantly higher in boys than in girls (P=0.048). The scale scores increased by 1.30 points in group 1 and decreased by 1.04 points in group 2 but there was no significant difference. Scale scores in each group showed no significant difference according to surgical outcome. Conclusions: In exotropia patients, there was no significant change in scale scores of ADHD after strabismus surgery.ope

Measuring photophobia using Optec 6500® in children with intermittent exotropia

의학과/석사[한글]간헐외사시 환자에서의 눈부심은 54~90%의 환자가 호소할 정도로 흔하지만 이를 객관적으로 측정한 연구는 거의 이루어져 있지 않다. 이에 본 연구에서는 최근 굴절교정수술과 백내장수술 전후 눈부심 측정에 이용되고 있는 Optec 6500®으로 간헐외사시 환자의 눈부심을 측정하고자 하였다. 간헐외사시로 수술예정인 환자 58명과 정상 대조군 34명을 대상으로 Optec 6500®의 대비감도 검사를 이용하여 눈부심을 측정하고 이를 비교하였다. 눈부심은 일정한 조도 조건에서 눈부심을 일으키는 빛 조건을 추가하였을 때 저하되는 대비감도의 차이로 정의하였다. 측정된 눈부심과 관련된 임상인자를 조사하였고, 사시수술 3개월 후 반복 측정하여 수술 전과 비교하였다. 간헐외사시군의 대비감도는 명소시 저 공간 주파수에서, 박명시에는 저중간 공간 주파수에서 대조군에 비해 저하되어 있었다. 또한 눈부심을 일으키는 빛 조건을 주면, 박명시 중간 공간 주파수에서 간헐외사시군의 대비감도가 감소되었고, 이러한 변화는 양안 검사시에만 나타났다. 이 측정된 눈부심은 수술 3개월 후 의미있게 호전되었다. 눈부심은 술전 사시각, 굴절이상, 억제정도, 유병기간, 나이, 성별과는 상관관계가 없었으나 술전 원거리 입체시가 좋을수록, 그리고 환자가 눈부심을 호소할 경우 강하게 측정되었다.간헐외사시 환자의 눈부심을 정량화할 수 있었으며, 이는 간헐외사시의 상태를 평가하는데 유용하게 사용될 수 있을 것으로 생각된다. [영문]ope

갑상샘눈병증 안와섬유모세포에서 interleukin-1β로 유도된 히알루론산 증가에 대한 pirfenidone의 억제 작용

Dept. of Medicine/박사Thyroid-associated ophthalmopathy (TAO) is an autoimmune component of Graves’ disease characterized by intense inflammation in the setting of volume expansion and tissue remodeling, leading to organ dysfunction. At the heart of this, tissue remodeling occurred by the disordered accumulation of glycosaminoglycan; hyaluronic acid (HA), which results in tissue edema due to its strong hydrophilic property. Because no reliable, specific and safe medical therapeutic agents are available for TAO, the development of specific therapies with minimal side effects is essential. Pirfenidone (5-methyl-1-phenyl-2-[1H]-pyridone) is a novel agent that has shown its anti-inflammatory and anti-fibrotic effects in animal models and clinical trials. We investigated an effect of pirfenidone on interleukin (IL)-1β-induced HA expression in an in vitro model of TAO. The effect of pirfenidone on IL-1β-induced HA expression was assessed in primary cultured orbital fibroblasts of TAO patients. The level of HA in IL-1β-treated cells with or without pirfenidone was measured using an enzyme-linked immunosorbent assay (ELISA). The effect of pirfenidone on IL-1β-induced hyaluronic acid synthase (HAS) expression was evaluated by reverse transcription-polymerase chain reaction (RT-PCR), and verified by Western blot. We then examined the role of mitogen-activated protein kinase (MAPK)s on IL-1β-induced HAS expression by RT-PCR, using specific inhibitors to p38 MAPK (p38), extracellular signal-regulated kinase (ERK), and c-Jun N-terminal kinase (JNK). The level of phosphorylation of MAPKs in IL-1β-treated cells with or without pirfenidone was measured by immunoblot analysis. In addition, the effect of pirfenidone on HA production was compared with that of dexamethasone by ELISA. Pirfenidone strongly attenuated the IL-1β-induced HA release with a dose -dependent manner. IL-1β-induced HAS mRNA and protein expression decreased significantly by co-treatment with pirfenidone. In the signaling pathway of IL-1β, HAS transcription was mediated by p38 and ERK dependent pathways, and the phosphorylations of them were nicely attenuated by co-treatments with pirfenidone. In our system, JNK pathways was not related with IL-1β-induced HAS transcription. Finally, pirfenidone was more effective than dexamethasone in inhibiting IL-1β-induced HA increases. In summary, pirfenidone attenuates the IL-1β-induced HA production in orbital fibroblasts from patients with TAO, which is related to suppression of the MAPK-mediated HAS expression. These results support the potential use of pirfenidone in treatment of TAO.ope

Surgical Results in Duane Retraction Syndrome

Purpose: To report the clinical characteristics and the results of a series of patients treated with various strabismus surgery techniques for Duane retraction syndrome (DRS). Methods: Thirty-eight patients with DRS undergoing surgical treatment were retrospectively reviewed. In all patients, ocular alignment, abnormal head posture and ocular motility disturbance were assessed both preoperatively and postoperatively. The patients were treated with appropriate horizontal muscle recession, Y-splitting combined with horizontal muscle recession, medial rectus recession and lateral rectus resection. Results: The incidence of DRS was greater in females and in the left eye. Type 1 was the most common, and esodeviation was seen most frequently in the primary position. The esotropic patients with DRS turned their faces toward the affected eyes, while the exotropic patients with DRS turned away from the affected eyes. The deviation in the primary position was reduced from an average of 15.0 prism diopters (PD) to 1.5PD. The face turn was reduced from an average of 17.5 degrees to 1.2 degrees. Conclusions: The primary deviation and abnormal head posture found in DRS can be improved by proper preoperative evaluation and adequate choice of surgical methodsope

Effectiveness of cultured human keratinocyte onlays on epithelial healing and clinical outcome after photorefractive keratectomy

PURPOSE: To evaluate epithelial healing time, postoperative pain, corneal haze, and visual and refractive outcomes following the application of cultured sheets of human allogeneic epidermal keratinocyte (CEAK) onlays on the photorefractive keratectomy (PRK) -ablated corneal surface as dressing material. METHODS: In total, 204 eyes from 103 patients with myopia or myopic astigmatism were prospectively evaluated for 6 months after PRK. The ablated cornea was dressed in three different ways. Specifically, CEAK onlays were placed in 80 eyes (CEAK group), CEAK with amniotic membrane (AM) strips in 63 eyes (CEAK with AM group), and therapeutic contact lenses only in 61 eyes (control group). All eyes were covered with bandage contact lens after the operation. Contact lens removal time, intensity of postoperative pain score on postoperative day 2, corneal haze, Snellen visual acuity, and remaining refractive errors were measured. RESULTS: The mean contact lens removal time was shorter in the CEAK with AM group (1.84 +/- 0.72 days) compared to the control (2.77 +/- 1.59 days) and CEAK only (2.24 +/- 0.79 days) groups (P < .001). However, no significant differences were evident among the groups in terms of immediate postoperative pain, Snellen visual acuity, remaining refractive errors, and corneal haze at 6 months postoperative. CONCLUSIONS: The CEAK onlay with AM facilitates epithelial healing, and is thus a good candidate dressing material to decrease the epithelial healing time after PRK. However, this onlay method did not affect the intensity of postoperative pain or final visual outcomes after surgeryope

Practical aspects and efficacy of intraoperative adjustment in concomitant horizontal strabismus surgery

PURPOSE: To analyze the practical aspects and advantages of one-stage adjustable surgery under topical anesthesia in concomitant horizontal strabismus. METHODS: A retrospective review of 363 patients was completed to assess (1) the frequency of need to perform adjustment, (2) the amount and pattern of adjustment, and (3) the final alignment at least 6 months after surgery. Intraoperative adjustment was performed strictly toward the aim of orthophoria or slight overcorrection (heterophoria < 6 prism diopters [PD]) while avoiding diplopia. RESULTS: Of the 363 patients, 261 (72%) required intraoperative adjustment. Of these, 85% of exotropes underwent a decreased amount of surgery compared with the standard amount, whereas 58% of esotropes underwent an increased amount of surgery. Forty-two patients underwent a one-muscle surgery instead of the scheduled two-muscle surgery, and all had less than 35 PD preoperative angle of deviation. Success rates were 83% in all patients with one-stage adjustable sutures and 87% in patients who underwent adjustment. In 42 patients with one-muscle surgery instead of two-muscle surgery, 32 (76%) obtained successful results. CONCLUSION: Intraoperative adjustment was effective in concomitant horizontal strabismus surgery and can provide the opportunity to avoid a large overcorrection, especially in cases with moderate angle horizontal muscle surgeryope

Topical 0.1% prednisolone lowers nerve growth factor expression in keratoconjunctivitis sicca patients

PURPOSE: To compare nerve growth factor (NGF) levels in tears and on the ocular surfaces of normal control and non-Sjögren's type keratoconjunctivitis sicca subjects, and to investigate the effect of 0.1% prednisolone eyedrops on NGF levels in keratoconjunctivitis sicca patients. DESIGN: Prospective, double-masked, randomized, comparative clinical trial. PARTICIPANTS: Forty-one keratoconjunctivitis sicca patients and 23 age- and gender-matched healthy subjects. METHODS: Baseline tear NGF levels were measured in keratoconjunctivitis sicca patients and healthy control subjects using enzyme-linked immunosorbent assays. Keratoconjunctivitis sicca patients received 0.1% prednisolone drops in one eye and 0.1% hyaluronic acid drops in the other, 3 times a day for 28 days. Also, impression cytology (IC) and immunostaining for NGF on conjunctival epithelium were performed on both groups. MAIN OUTCOME MEASURES: Tear NGF/total tear protein (TP) concentration ratio, IC and NGF immunocytologic staining, subjective symptom scale, tear breakup time, and Schirmer values. RESULTS: Keratoconjunctivitis sicca patients were found to have baseline tear NGF concentrations higher than those of age- and gender-matched healthy control subjects (65.9+/-14.5 vs. 122.1+/-45.3 pg/mug, P<0.0001). In keratoconjunctivitis sicca patients, prednisolone treatment for 28 days resulted in a decrease in tear NGF levels, symptom scores, and IC scores, whereas hyaluronic acid treatment had no such effect (68.2+/-25.0 pg/mug vs. 108.0+/-43.4 pg/mug, P<0.0001 for tear NGF/TP ratio; 2.16+/-1.01 vs. 3.39+/-1.50, P = 0.0014 for symptom scale; 1.05+/-0.67 vs. 1.61+/-0.86, P = 0.0317 for IC). Measurements taken at both 14 and 28 days indicated that neither prednisolone nor hyaluronic acid treatment affected breakup time or Schirmer values. CONCLUSION: Keratoconjunctivitis sicca patients showed elevated levels of tear NGF, which were decreased by treatment with 0.1% prednisolone. These data suggest that ocular surface NGF may play an important role in ocular surface inflammation processes associated with dry eyes.ope

Topical 0.1% Prednisolone Lowers Nerve Growth Factor Expression in Keratoconjunctivitis Sicca Patients

Purpose: To compare nerve growth factor (NGF) levels in tears and on the ocular surface of normal controls with those of non-Sjogren type keratoconjunctivitis sicca (KCS) subjects, and investigate the effect of 0.1% prednisolone eye drops on NGF levels in KCS patients. Methods: Baseline tear NGF levels were measured in 41 KCS patients and 23 healthy control subjects using enzyme-linked immunosorbent assays (ELISA). KCS patients received 0.1% prednisolone drops in one eye, and 0.1% hyaluronic acid drops in the other eye, three times daily for 28 days. Impression cytology (IC) and immunostaining for NGF on conjunctival epithelium was performed for both groups. Results: KCS patients were found to have higher baseline tear NGF concentrations compared to age-and sex-matched healthy control subjects (65.9±14.5 vs. 122.1±45.3, p<0.0001). In KCS patients, prednisolone treatment for 28 days resulted in a decrease in tear NGF levels, symptom scores and IC scores, whereas hyaluronic acid treatment had no such effect (68.2±25.0 pg/μg vs. 108.0±43.4 pg/μg, p<0.0001 for tear NGF/TP ratio; 2.16±1.01 vs. 3.39±1.50, p=0.0014 for symptom scale; 1.05±0.67 vs. 1.61±0.86, p=0.0317 for IC). Measurements taken at both 14 and 28 days indicate that neither prednisolone nor hyaluronic acid treatment affected BUT or Schirmer values. Conclusions: KCS patients showed elevated levels of tear NGF, which were decreased by treatment with 0.1% prednisolone. These data suggest that the ocular surface NGF may play an important role in ocular surface inflammation processes associated with dry eyes.ope

Change in ocular alignment after topical anesthetic cataract surgery

BACKGROUND: To report the incidence of, and change in ocular misalignment following topical anesthetic cataract surgery. METHODS: Prospectively, 160 consecutive patients who were scheduled for cataract surgery under topical anesthesia were evaluated. All patients had a complete ophthalmic examination, including ocular alignment evaluation, just before and 1 day, 1 week, 3 weeks, and 2 months after cataract surgery. RESULTS: Preoperatively, 26 patients had ocular misalignment. Mean deviation in these preexisting misalignment was 7.2 +/- 6.8 prism diopters (PD). Postoperatively, the angle of deviation improved to 5.4 +/- 7.4 PD. Acquired ocular misalignment after cataract surgery occurred in 12 of 160 patients (8%) at 1 day, and seven of 131 (5%) at 2 months. None of these seven patients sought medical attention for the diplopia. CONCLUSIONS: The overall incidence of topical anesthesia-related change in ocular alignment after uneventful cataract surgery was 5%. However, no patients had symptomatic diplopia. Topical anesthetic cataract surgery could abolish the risk of postoperative diplopia and improve the heterophoric status of preexisting misalignmentope