Self-Reported Findings of the Korean Intermittent Exotropia Multicenter Study Questionnaire.

PURPOSE: To determine subjective symptoms and medical history of patients with intermittent exotropia in a large study population. METHODS: The Korean Intermittent Exotropia Multicenter Study (KIEMS) is a nationwide, observational, cross-sectional, multicenter study conducted by the Korean Association for Pediatric Ophthalmology and Strabismus including 5,385 patients with intermittent exotropia. Subjective symptoms and medical history of patients with intermittent exotropia were extracted by a comprehensive survey based on a self-administered questionnaire according to the study protocol of the KIEMS. RESULTS: The mean age of symptom onset was 5.5 years. The most common symptom reported in patients with intermittent exotropia was photophobia (52.1%), followed by diplopia at near fixation (7.3%) and distance fixation (6.2%). Preterm birth was found in 8.8%, and 4.1% had perinatal complications. A family history of strabismus was present in 14.9%, and 5.5% of patients had a family member who underwent strabismus surgery. CONCLUSIONS: The KIEMS is one of the largest clinical studies on intermittent exotropia. Intermittent exotropia frequently caused photophobia and diplopia, and patients with a family history was not uncommon.

Longitudinal analysis of refraction and ocular biometrics in preschool children with early-onset high myopia.

We investigated changes in refraction and ocular biometrics in preschool children with early-onset high myopia. Sixty eyes of 60 children with a mean follow-up time of 58.5 months were included in this study. At baseline, mean age of children was 55.6 ± 13.1 months, mean spherical equivalent (SE) was - 8.59 ± 2.66 D, and 25.64 ± 1.16 mm for axial length (AL). The total annual rate of myopic progression and axial elongation were - 0.37 ± 0.39 D/year and 0.33 ± 0.18 mm/year, respectively. During follow-up period, there was a trend toward less myopic progression and axial elongation over time. Of the total participants, 24 children (40%) were in the myopia progression group and the remaining 36 children (60%) were in the myopia stability group. In multiple linear regression analysis, baseline SE and AL were independently associated with myopic progression, while age, sex, and baseline AL-to-CR ratio were not related to myopic progression. According to the model, more myopic SE (ß = - 0.186, P = 0.035) and longer AL (ß = - 0.391, P = 0.008) at baseline were significantly associated with myopic progression. Myopia progression in preschoolers with high myopia tended to be relatively modest, with 60% of subjects exhibited myopic stability. Higher myopic SE, and longer AL at baseline were associated with myopic progression in preschool children with high myopia.

Macular superficial vascular density on optical coherence tomography angiography in children with unilateral anisometropic and bilateral hyperopic amblyopia.

We analyzed whether macular superficial vascular density (SVD) and foveal vascular zone (FAZ) on optical coherence tomography angiography (OCTA) can distinguish between bilateral ametropic and anisometropic amblyopia. We included 42, 33, and 50 eyes in the bilateral ametropic amblyopia, anisometropic amblyopia, and normal control groups, respectively. Using macular swept-source optical coherence tomography angiography, we measured and analyzed the superficial FAZ areas and five sectoral macular SVDs after magnification correction. The anisometropic amblyopic eye group showed significantly increased foveal SVDs (p < 0.001) and significantly decreased superficial FAZ areas (p < 0.001), compared with the remaining groups. Additionally, the bilateral ametropic amblyopia group had significantly decreased nasal SVDs. SVDs and superficial FAZ areas differed among hyperopic amblyopia subtypes. These findings may reflect vascular distribution differences and macular changes in hyperopic amblyopia subtypes compared with normal eyes.

SiO-induced thermal instability and interplay between graphite and SiO in graphite/SiO composite anode.

Silicon monoxide (SiO), which exhibits better cyclability compared to silicon while delivering higher capacity than that of graphite, is an adequate material for the development of lithium-ion batteries (LIBs) having higher energy densities. However, incorporating silicon-based materials including SiO into stable graphite anode inevitably degrades not only cycle life but also calendar life of LIBs, while little is known about their aging mechanisms. Here, SiO-induced thermal instability of the graphite/SiO composite anode is investigated. We reveal that under thermal exposure, SiO accelerates the loss of lithium inventory and concomitantly facilitates the lithium de-intercalation from graphite. This self-discharge phenomenon, which is weakly observed in the graphite anode without SiO, is the result of preferential parasitic reaction on the SiO interface and spontaneous electron and lithium-ion migration to equilibrate the electron energy imbalance between graphite and SiO. Understanding this underlying electron-level interplay between graphite and SiO in the composite anode will contribute toward improving shelf life of SiO-containing LIBs in actual operating conditions.

Diagnostic performance of the Spot vision photoscreener for the detection of exodeviation in preschool-aged children.

PURPOSE: To evaluate the diagnostic performance of the Welch Allyn Spot Vision photoscreener in preschool children for detecting exotropia, the most prevalent type of strabismus among Asian children. METHODS: Children aged 3-6 years were screened using the Spot Vision photoscreener and then underwent a complete ophthalmologic examination on the same day. A child with exodeviation ≥8 Δ in the primary position using the cover-uncover test and the alternate prism cover test was confirmed to have exotropia. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the photoscreener in detecting exotropia were calculated. Subgroup analyses were performed according to the angle of deviation (≥25 Δ vs. <25 Δ) and fusional control (good/fair vs. poor). RESULTS: Two hundred and ten children were included in this study. Among 80 exotropia-confirmed children, 23 needed referrals for exodeviation (screening-positive) and 57 were proven to be screening-negatives with the photoscreener. The overall sensitivity, specificity, PPV and NPV of the photoscreener for detecting exotropia were 28.8%, 95.4%, 79.3% and 68.5%, respectively. The positive and negative likelihood ratios were 6.26 and 0.75, respectively. Compared with the 57 children with false-negatives (71.3%), those with true-positive results with the photoscreener had significantly larger angles of exodeviation (p = 0.02) and a higher proportion of poor fusional control (p = 0.004). The photoscreener had low sensitivity even in detecting exotropia ≥25 Δ or those with poor fusional control (35.2% and 43.6%, respectively). Approximately 65% (42 out of 64) of the children with a significant exodeviation which needed strabismus surgery were not identified by the Spot Vision Photoscreener. CONCLUSIONS: The Spot Vision photoscreener has low sensitivity for detecting exodeviation. It should not be used alone for assessing exotropia in preschool-aged children.

Ocular biometric changes following unilateral cataract surgery in children.

PURPOSE: To analyze ocular biometric changes following unilateral cataract surgery in children. METHODS: A total of 57 children aged under 13 years who underwent unilateral cataract surgery were analyzed. Groups were classified according to their age at surgery: group I (age <3), II (3≤ age <6), III (6≤ age <9), and IV (age ≥9). The myopic shift, axial growth, and corneal curvature changes were compared between the pseudophakic eyes and the fellow phakic eyes. RESULTS: During 7.81 ± 4.39 years, the overall myopic shift (D) and the rate of myopic shift (D/year) were significantly higher at -3.25 ± 3.21 D and -0.45 ± 0.44 D/year in the pseudophakic eyes than -1.78 ± 2.10 D and -0.22 ± 0.29 D/year in the fellow phakic eyes (P = 0.01, 0.004). Group I (-1.14 ± 0.66 vs -0.02 ± 0.45 D/year) and group II (-0.63 ± 0.37 vs -0.31 ± 0.29 D/year) showed significantly higher rate of myopic shift in the pseudophakic eyes than in the phakic eyes. The rate of myopic shift in the pseudophakic eyes decreased in the older age groups (P = 0.001). There was no significant between-eye difference in the changes in axial length and keratometric values postoperatively. CONCLUSION: Following unilateral cataract surgery, a significant postoperative myopic shift was noticed in the pseudophakic eyes compared to the fellow phakic eyes in groups under 6 years old. Postoperative myopic shift and the resultant anisometropia should be considered when selecting the optimal power of IOL in young children requiring unilateral cataract surgery.

Over-Expression of Dehydroascorbate Reductase Improves Salt Tolerance, Environmental Adaptability and Productivity in Oryza sativa.

Abiotic stress induces reactive oxygen species (ROS) generation in plants, and high ROS levels can cause partial or severe oxidative damage to cellular components that regulate the redox status. Here, we developed salt-tolerant transgenic rice plants that overexpressed the dehydroascorbate reductase gene (OsDHAR1) under the control of a stress-inducible sweet potato promoter (SWPA2). OsDHAR1-expressing transgenic plants exhibited improved environmental adaptability compared to wild-type plants, owing to enhanced ascorbate levels, redox homeostasis, photosynthetic ability, and membrane stability through cross-activation of ascorbate-glutathione cycle enzymes under paddy-field conditions, which enhanced various agronomic traits, including root development, panicle number, spikelet number per panicle, and total grain yield. dhar2-knockdown plants were susceptible to salt stress, and owing to poor seed maturation, exhibited reduced biomass (root growth) and grain yield under paddy field conditions. Microarray revealed that transgenic plants highly expressed genes associated with cell growth, plant growth, leaf senescence, root development, ROS and heavy metal detoxification systems, lipid metabolism, isoflavone and ascorbate recycling, and photosynthesis. We identified the genetic source of functional genomics-based molecular breeding in crop plants and provided new insights into the physiological processes underlying environmental adaptability, which will enable improvement of stress tolerance and crop species productivity in response to climate change.

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) in children.

BACKGROUND: To analyse structural characteristics and perifoveal/peripapillary vasculature by OCT in children with peripapillary hyperreflective ovoid mass-like structures (PHOMS) and compare the results with those of normal subjects. METHODS: Forty-five patients (84 eyes) under 18 years old with blurry disc margin were evaluated with spectral domain-OCT and swept course-OCT. Patients were divided into four groups, according to presence of PHOMS and then the size of the existing PHOMS. Eyes with visible optic disc drusen (ODD) were not included. Foveal avascular zone (FAZ) and vessel densities from macula and optic disc area were assessed and potential associations between vessel density and structural parameters, such as peripapillary retinal nerve fibre layer (pRNFL), and macular ganglion cell and inner plexiform layer (mGCIPL) thickness, were analysed. RESULTS: Among 45 patients (eighty-four eyes), coexisting buried ODD were found only in eyes with PHOMS. The scleral canal diameter was significantly smaller in PHOMS positive eyes compared to control eyes. Vessel density measurements from the papillary, peripapillary and optic nerve head (ONH) regions in the large PHOMS group were significantly lower compared to the control group (papillary; P = 0.014, peripapillary; P = 0.001, ONH; P = 0.046). FAZ area and macular vessel densities showed no difference compared to normal eyes in all three PHOMS groups. pRNFL and mGCIPL thickness did not differ among four groups and correlations were also not significant. CONCLUSIONS: Children with PHOMS have smaller scleral canal and can entail buried ODD. Vessel densities of optic disc area in large PHOMS eyes are significantly lower than in normal eyes.

Morphological change of the posterior pole following the horizontal strabismus surgery with swept source optical coherence tomography.

Extraocular muscle movement during strabismus surgery causes changes in eyeball shape. Because extraocular muscle insertion is in front of the equator, it is thought that changes due to strabismus surgery mainly occur in the anterior segment. However, changes in the posterior segment of eye may also occur, which may also result in changes in refractive error after strabismus surgery. Using a 3-dimensional reconstruction technique (en face imaging) of the swept source optical coherence tomography, we determined and quantitatively measured the posterior polar change. The deepest interface between Bruch's membrane and the choroid could be identified as the deepest point of the eyeball (DPE), and the location of the DPE relative to the optic disc and the fovea was measured. After lateral rectus muscle recession, the DPE moved away from the fovea, but after medial rectus muscle recession, the DPE moved toward the fovea. The amount of DPE movement differed by age and preoperative refractive error. Our findings suggest that the positional shift of the rectus muscle in horizontal strabismus surgery causes a structural change in the posterior segment of the eye, and the postoperative refractive changes may be related to this shift.

Influence of coronavirus disease 2019 on myopic progression in children treated with low-concentration atropine.

PURPOSE: The outbreak of coronavirus disease 2019 (COVID-19) has caused many children to stay indoors. Increased near work and insufficient outdoor activities are considered important risk factors for myopic progression. This study aimed to compare the changes in myopic progression before and after COVID-19 in children treated with low-concentration atropine. METHODS: The records of 103 eyes of 103 children who were treated with low-concentration atropine eye drops were retrospectively reviewed. We classified children according to the concentration of atropine eye drops and children's age. The beginning of the pre-COVID-19 period was set from January 2019 to May 2019, and the endpoint was set in March 2020. The beginning of the post-COVID-19 period was set in March 2020, and the endpoint was set from January 2021 to March 2021. We evaluated the questionnaires administered to children's parents. RESULTS: A significant myopic progression was observed in the post-COVID-19 period compared to the pre-COVID-19 period in the 0.05% and 0.025% atropine groups (P < 0.001 and P = 0.020, respectively). For children aged 5 to 7 and 8 to 10 years, the axial elongations were significantly faster in the post-COVID-19 period than in the pre-COVID-19 period (P = 0.022 and P = 0.005, respectively). However, the rates of axial elongation and myopic progression were not significantly different between pre- and post-COVID-19 in children aged 11 to 15 years (P = 0.065 and P = 0.792, respectively). The average time spent using computers and smartphones and reading time were significantly increased, and the times of physical and outdoor activity were significantly decreased in the post-COVID-19 period compared to the pre-COVID-19 period. CONCLUSIONS: The rates of myopic progression have increased substantially after the spread of COVID-19 with an increase in the home confinement of children. Therefore, it is necessary to control the environmental risk factors for myopia, even in children undergoing treatment for the inhibition of myopic progression.

Change of ocular parameters in children with large cup-to-disc ratio and interocular cup-to-disc ratio asymmetry.

BACKGROUND: Enlarged optic disc cupping and interocular cup-to-disc ratio (CDR) asymmetry are often important indicators of glaucoma. Clinically, we occasionally encounter children with large CDR and interocular CDR asymmetry during vision screening. This study aimed to report longitudinal change of ocular parameters in children with large cup-to-disc ratio (CDR) and interocular CDR asymmetry. METHODS: This was a retrospective, observational case series of 160 eyes of 160 children with large CDR who visited a tertiary eye center from January 2010 to June 2016. Average CDR ≥ 0.6 were considered large CDR values, and CDR asymmetry was defined as an interocular difference ratio value greater than 0.2. All included patients showed interocular pressure (IOP) < 21 mmHg at least three ophthalmic examinations conducted at total intervals of at least 30 months. RESULTS: The mean age of children included in the study was 7.14 ± 2.42 years, with a follow-up period of 54.46 ± 19.82 months. Changes in refractive error and axial length were significantly different between initial and final examination (p < 0.001). However, optic nerve head (ONH) analysis and retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thicknesses were not significantly different between initial and final examination. In interocular comparisons of patients with CDR asymmetry, changes of refractive error, axial length, ONH analysis, and RNFL and mGCIPL thickness were not significantly different between the two eyes. CONCLUSIONS: There were no significant differences in the changes of ONH analysis, and RNFL and mGCIPL thicknesses in children with large CDR, or those with interocular CDR asymmetry over the study period. Our results provide helpful information for the establishment of guidelines for managing children with large CDR and interocular CDR asymmetry.

Oculocardiac reflex and oculorespiratory reflex during strabismus surgery under general anesthesia using the laryngeal mask airway with maintenance of spontaneous respiration: A retrospective study.

OBJECTIVE: To determine (1) how the specific muscle undergoing surgical treatment affects the occurrence of the oculocardiac reflex (OCR) and oculorespiratory reflex (ORR) and (2) whether the depth of anesthesia influences the occurrence of the OCR and ORR in patients undergoing strabismus surgery with a laryngeal mask airway with maintenance of spontaneous respiration. METHODS: The medical records of patients who underwent strabismus surgery on the lateral rectus (LR) and medial rectus (MR) muscles from January 2017 to December 2017 were retrospectively reviewed. RESULTS: The incidence of the OCR was not significantly different between LR and MR operations in either pediatric or adult patients. The incidence of the ORR as indexed by the tidal volume (TV) was significantly higher during MR than LR surgery in pediatric patients (29.3% vs. 10.1%, respectively). The change in TV during muscle traction and the bispectral index were significantly correlated in both pediatric and adult patients (r2 = 0.034 and 0.058, respectively). CONCLUSIONS: The OCR was not influenced by the specific muscle undergoing surgery or the depth of anesthesia. The incidence of the ORR as indexed by the TV was higher during MR surgery in pediatric patients and was positively correlated with the depth of anesthesia.

Long term change of the optic disc and OCT parameters during myopic shift in children with large cup to disc ratio.

PURPOSE: This observational case series was to determine long term optic disc changes in eyes with large cup to disc ratio (CDR) and compare the changes induced by myopic shift during childhood with normal control eyes. METHODS: Children under 15 years of age who developed myopia with serial optic disc photographs and spectral domain (SD)-optical coherence tomography (OCT) images with a minimal interval of three years were evaluated. Children with average CDR ≥ 0.6 on SD-OCT were classified as having large CDR. The ratios of vertical disc diameter (VDD), horizontal disc diameter (HDD), and maximum peripapillary atrophy (PPA) width (PPW) were measured to quantify morphologic changes of optic discs and SD-OCT parameters, such as peripapillary retinal nerve fiber layer (RNFL) thickness and macular ganglion cell and inner plexiform layer (GCIPL) thickness were measured. RESULTS: Of the 82 eyes (82 patients) analyzed, 42 eyes had large CDR and 40 eyes were normal controls. The mean age and refractive error at initial examination were not different between groups (P = 0.33, P = 0.76, respectively). The changes in HDD/VDD and PPW/VDD ratios during follow-up showed no significant difference among the groups (P = 0.45, P = 0.62, respectively). No statistical significance was found in changes in RNFL and GCIPL thickness between the two groups (P = 0.74, P = 0.79, respectively). CONCLUSIONS: Children with enlarged CDR showed changes in optic disc morphology and RNFL/GCIPL thickness similar to normal children during myopic shift.

Genotypic and phenotypic characteristics of Korean children with childhood-onset Leber's hereditary optic neuropathy.

PURPOSE: We sought to identify the phenotypic and genotypic characteristics of Korean children with genetically confirmed Leber's hereditary optic neuropathy (LHON). METHODS: The medical records of 64 genetically confirmed LHON patients were reviewed. Seventeen patients aged 13 years or younger with optic atrophy with positive mitochondrial DNA (mtDNA) mutations were considered to demonstrate childhood-onset LHON. The non-childhood-onset group included 47 patients with genetically confirmed LHON who experienced disease onset later than 13 years of age. The type of mtDNA mutation, visual acuity (VA), color vision, fundus photography, retinal nerve fiber layer (RNFL) thickness, and visual field were investigated. RESULTS: Sequence analysis of the mitochondrial genome revealed five different kinds of LHON-associated mtDNA mutations among our childhood-onset patients, including m.11778G>A (58.8%), m.3496G>T (11.8%), m.3497C>T (5.9%), m.11696G>A (5.9%), and m.14502T>C (5.9%). The mean final best-corrected VA in the childhood-onset group was better than that in the non-childhood-onset group with the value of logMAR 0.29 (0.09-0.75) vs. 0.55 (0.27-1.29) (expressed as median (interquartile range); p = 0.05). Spontaneous visual recovery was observed in 35.3% of the childhood-onset group but in only 12.8% of the non-childhood-onset group (p = 0.04). Eight patients (47.1%) showed interocular asymmetry of the disease, with two presenting true unilateral involvement of the optic nerve and the other six patients demonstrating unilateral subclinical manifestations with bilateral optic atrophy. CONCLUSION: Involvement of secondary mitochondrial mutations was confirmed in patients with childhood-onset LHON. Characteristic clinical features of childhood-onset LHON included a higher proportion of subacute or insidious onset of symptoms, better VA, higher spontaneous recovery, and asymmetrical ocular involvement.

Segmented retinal layer analysis of chiasmal compressive optic neuropathy in pituitary adenoma patients.

AIMS: To evaluate changes in the segmented retinal layers of pituitary adenoma (PA) patients and to identify the relationship between these changes and visual function. METHODS: A total of 47 (PA patients) and 22 (healthy subjects) eyes were reviewed from the medical records. The PA patients performed a visual field (VF) test before surgery and 1 month after surgery. By optical coherence tomography scanning, eight retinal layers were measured: retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer, outer nuclear layer, retinal pigment epithelium, and photoreceptor layer. RESULTS: The PA group showed reduced RNFL, GCL, and IPL thicknesses (p = 0.004,< 0.001,< 0.001) and thicker INL thickness (p = 0.012) than did the controls. The mean deviation of preoperative VF in the PA group was positively correlated with RNFL, GCL, and IPL thicknesses (R = 0.664, 0.720, 0.664; p < 0.001,< 0.001,< 0.001) and negatively correlated with the INL thickness (R = -0.400; p = 0.010). Among the 47 eyes, 32 eyes (68%) were included for subgroup analysis. Preoperative RNFL, GCL, and IPL thicknesses were thicker in the postoperatively improved VF group (p = 0.019, 0.009, 0.005). The preoperative cutoff values for visual recovery were 23.6 µm for RNFL thickness, 30.6 µm for GCL thickness, and 28.9 µm for IPL thickness. CONCLUSION: During chiasmal compression, the thickening of the INL has presented in addition to thinning of the inner retinal layers. Also, changes in retinal anatomical structures are related to the extent of VF defect and can be used as a predictor of postoperative visual recovery.

Interocular difference associated with myopic progression following unilateral lateral rectus recession in early school-aged children.

PURPOSE: To compare refractive changes in operated eyes and fellow unoperated eyes following unilateral lateral rectus recession in early school-aged children. STUDY DESIGN: A retrospective case control study. METHODS: The medical records of children under ten years of age with intermittent exotropia who underwent unilateral lateral recession surgery were reviewed. The operated eyes were reviewed and the fellow unoperated eyes were used as control. The rate of myopic progression was calculated by spherical equivalent (SE) changes per year, and by the rate of refractive growth (RRG) equation. RESULTS: SE showed a myopic shift one week after surgery and in the following months, from -1.43 ± 1.84 diopters (D) at 1 week post operation to -1.57 ± 2.22 D at one year and, finally -2.95 ± 2.97 D at the average 4.62 years following surgery. However, the SE shift was not significantly different from the unoperated eye. The low myopia group (under -3.0 D) showed a significantly higher myopic change in the operated eye until one year post operation (p = 0.022). The average myopic shift ratio was -0.53 ± 0.46 D yearly in the operated eye. CONCLUSIONS: This study presents data of a large series of refractive changes secondary to lateral rectus recession, and of long-term myopia progression in Korean population.

Detailed anatomy of the trochlear nerve in the superior oblique muscle.

PURPOSE: The purpose of this study was to elucidate the detailed anatomy of the trochlear nerve in the superior oblique muscle (SOM) and the intramuscular innervation pattern using Sihler staining. METHODS: SOMs were dissected from their origin to the insertion in 28 eyes of 14 cadavers. The following distances were determined: from the SOM insertion to the trochlear, from the trochlear to the entry site of the anterior branch or posterior branch, and the widths of the main trunk and anterior and posterior branches. Sihler staining was then performed. RESULTS: The trochlear nerve traveled straight ahead medially and divided. Eighteen of 28 (64.3%) orbits showed two anterior and posterior branches, six (21.4%) showed three branches, and four (14.3%) showed no branching. The most distally located intramuscular nerve ending was observed at 62.4 ± 2.4% of the length of each muscle (35.8 mm from insertion when considering that the length of the SOM was 57.4 mm) and at 29.9 ± 3.2% of the length of each muscle (17.2 mm from the trochlear). Additionally, the length of the intramuscular arborization part was 9.4 ± 1.1% of the length of the SOM (5.4 mm when considering that the length of the SOM was 57.4 mm). Nonoverlap between two intramuscular arborizations of the nerve was detected in 20 of 28 cases (71.4%). Eight cases (28.6%) showed a definite overlap of two zones. CONCLUSIONS: This study provided a good understanding of the anatomy of the trochlear nerve in the SOM.

Detailed Anatomy of the Lateral Rectus Muscle-Superior Rectus Muscle Band.

BACKGROUND: To elucidate the detailed anatomy of the lateral rectus muscle-superior rectus muscle (LR-SR) band by cadaver eye investigation. METHODS: In total, 48 eyes of 24 cadavers were observed macroscopically. The lateral rectus muscle (LRM) and superior rectus muscle (SRM) were dissected from their origins to their insertions under the dissecting microscope, and the location, width, length, and tensile strength of the LR-SR bands were measured. RESULTS: The LR-SR band is the thick ligament interconnecting LRM pulleys with SRM pulleys. The LR-SR band was covered by the orbital part of the lacrimal gland superiorly, and the intermuscular septum between the LRM and SRM was shown anterior to the LR-SR band. The length of the attachment site between the LR-SR band and the SRM was less at 8.64 ± 1.52 mm (p=0.040), its thickness was thinner at 0.74 ± 0.16 mm (p=0.002), and its tensile strength was weaker at 7.64 ± 1.82 N (p=0.028) compared to the attachment site between the LR-SR band and the LRM. CONCLUSIONS: This study revealed the detailed anatomy of the LR-SR band and provided helpful information to understand heavy eye syndrome and sagging eye syndrome.

Surgical and sensory outcomes in patients with intermittent exotropia according to preoperative refractive error.

BACKGROUND/OBJECTIVES: To analyze the surgical and sensory outcomes of intermittent exotropia according to refractive errors and the factors associated with surgical success. SUBJECTS/METHODS: A total of 326 children were divided into three groups according to preoperative refractive error; hyperopic eyes with SE ≥+2D (hyperopic group), eyes with SE between -1D and +2D (emmetropic group), and myopic eyes with SE ≤-1D (myopic group). The surgical outcomes and the sensory outcomes measured by near and distant stereoacuity were compared among the three groups. RESULTS: The surgical success rate in hyperopic group was significantly lower compared to myopic group at last follow-up (P = 0.012). Preoperative near stereopsis was not different among three groups, however, the distance stereopsis was significantly deteriorated in the hyperopic group compared to the other two groups (Titmus; P = 0.168, FD2; P < 0.001, DR; P = 0.048). There was postoperative improvement in both near and distant stereopsis in all three groups (Titmus; P = 0.009, FD2; P = 0.021, DR; P = 0.036) and no significant difference was found in the postoperative distant stereopsis among the three groups. CONCLUSIONS: Preoperative refractive error is a prognostic factor of surgical success in patients with intermittent exotropia. Patients with hyperopia achieved less favorable surgical outcome compared to myopic patients. The preoperative distant stereoacuity was decreased in hyperopic patients compared to myopic patients, which eventually improved after surgery and showed no significant difference at postoperative measurements.

Changes in axial length in accommodative esotropia patients with minimal hyperopic correction.

PURPOSE: To compare the changes of spherical equivalent refractive error (SER) and axial length (AL) for three years in hyperopic children with minimal undercorrection according to the presence of accommodative esotropia (AE). METHODS: A total of 67 hyperopic children were enrolled. The patients were divided into 3 groups and matched by initial age upon examination; esotropic eyes with AE (AE group), fellow eyes with AE (FE group), and right eyes without esotropia (HE group). Changes of SER and AL were serially measured every six months for three years and collected data were compared among the groups. RESULTS: All three groups underwent significant myopic shift and AL elongation during the follow-up period. However, the least amount of change was found in the AE group. The AE group (-0.96 ± 1.38D) exhibited significantly less change in SER compared to the HE group (-1.76 ± 1.11D) and the FE group (-1.57 ± 1.33D) (both p<0.001). Meanwhile, smaller changes of AL were noticeable in the AE group (0.62 ± 0.88mm) compared to the other two groups (HE 0.99 ± 0.29mm; p<0.001, FE 0.73 ± 0.65mm; p = 0.04). The SER and AL changes were not significantly different between the HE group and FE group. CONCLUSIONS: Esotropic eyes with AE patients with minimal undercorrection exhibited little negative shift of SER and AL elongation compared to not only hyperopic eyes without AE but also fellow eyes with AE.