A Case of Odontogenic Orbital Cellulitis Causing Blindness by Severe Tension Orbit

We report a very rare case of odontogenic orbital cellulitis causing blindness by severe tension orbit. A 41-yr old male patient had visited the hospital due to severe periorbital swelling and nasal stuffiness while he was treated for a periodontal abscess. He was diagnosed with odontogenic sinusitis and orbital cellulitis, and treated with antibiotics. The symptoms were aggravated and emergency sinus drainage was performed. On the next day, a sudden decrease in vision occurred with findings of ischemic optic neuropathy and central retinal artery occlusion. Deformation of the eyeball posterior pole into a cone shape was found from the orbital CT. A high-dose steroid was administered immediately resulting in improvements of periorbital swelling, but the patient's vision had not recovered. Odontogenic orbital cellulitis is relatively rare, but can cause blindness via rapidly progressing tension orbit. Therefore even the simplest of dental problems requires careful attention.

The Short-Term Efficacy of Intravitreal Ranibizumab for Macular Edema in Central Retinal Vein Occlusion

PURPOSE: To evaluate the short-term efficacy of intravitreal ranibizumab injection in eyes with macular edema secondary to central retinal vein occlusion (CRVO). METHODS: The records of 17 patients (17 eyes, 11 ischemic, six ischemic) who received an intravitreal ranibizumab injection for macular edema secondary to CRVO were retrospectively analyzed. The ophthalmic examination included best corrected visual acuity (BCVA) and central macular thickness (CMT) at baseline and follow-up visits. RESULTS: After intravitreal ranibizumab injection, the mean BCVA improved from log MAR 1.25 +/- 0.47 at baseline to log MAR 0.78 +/- 0.49 at 4 weeks and to log MAR 0.81 +/- 0.52 at 12 weeks (p < 0.05). Additionally, the mean CMT decreased from 679.4 +/- 230.5 microm at baseline to 224.4 +/- 129.9 microm at 4 weeks and to 271.6 +/- 174.1microm at 12 weeks (p < 0.001). In subgroup analysis, the decreases in CMT at 4 weeks and 12 weeks were similar in ischemic CRVO and non-ischemic CRVO, but no significant changes in visual acuity were found at 12 weeks in the ischemic CRVO group (p = 0.138). Ten eyes (58.8%) did not require re-injections for macular edema for up to 12 weeks. CONCLUSIONS: Intravitreal ranibizumab injection appeared to be an effective option for the treatment of macular edema secondary to central retinal vein occlusion.

Comparison of the Effects of Patterned and Conventional Laser Photocoagulation in Branch Retinal Vein Occlusion

PURPOSE: To compare the clinical effect and complications between patterned laser photocoagulation with short exposure time and conventional laser photocoagulation for neovascularization in branch retinal vein occlusion (BRVO). METHODS: A prospective study was conducted on 36 patients (39 eyes) who required laser photocoagulation for neovascularization due to BRVO. The patients were divided into 2 groups, the patterned laser photocoagulation group (laser exposure time 0.02 sec, 3 x 3 array patterned photocoagulation) and conventional laser photocoagulation group (laser exposure time 0.2 sec). Other laser parameters (burn intensity and spot size) were the same. Pain score at the time of treatment was monitored after the laser photocoagulation. In addition, best-corrected visual acuity as well as central macular thickness measurements were performed before the treatment and after 2, 4, 8, and 12 weeks. The regression of neovascularization in fluorescein angiography was monitored during follow-up periods. RESULTS: The patterned laser photocoagulation group had a greater reduction in pain during laser photocoagulation, and a decreased change in central macular thickness after laser photocoagulation than the conventional laser photocoagulation group. In particular, the patterned laser photocoagulation group had a statistically significant difference between the 2 groups at postoperative 8 and 12 weeks. The regression rate of neovascularization between the 2 groups had no statistically significant difference. CONCLUSIONS: Patterned laser photocoagulation with a short exposure time decreases pain and postoperative macular edema with no difference in regression of neovascularization. Patterned laser photocoagulation with a short exposure time can be considered as a useful and efficient method for neovascularization in BRVO.

Stability of Four-Haptic Intraocular Lens in Combined Phacoemulsification and Vitrectomy

PURPOSE: To evaluate the stability of intraocular lenses (IOLs) according to the haptic design in combined surgery (phacoemulsification, intraocular lens insertion, and vitrectomy) by comparing early IOP elevation and the accuracy of IOL power. METHODS: A retrospective study was conducted for 85 eyes of 85 patients who had undergone combined surgery. IOP elevation one week postoperatively and the difference between target refraction and postoperative refraction after two months were evaluated in all patients. All eyes were allocated to either a 2-haptic IOL group or a 4-haptic IOL group, and then each group was divided into three subgroups: gas-filled, silicone oil-filled, or balanced salt solution-filled. RESULTS: In the balanced salt solution-filled group, the early IOP increase was significantly less in the 4-haptic IOL group than it was in the 2-haptic IOL group (3.24 mmHg vs. 6.15 mm Hg, p=0.025). The myopic shifts of the 2-haptic IOL group were significantly greater than those of the 4-haptic IOL group for all of the subgroups (gas subgroup -0.71D vs. -0.31D, p=0.045; balanced salt solution subgroup -0.66D vs. -0.16D, p=0.018). CONCLUSIONS: In combined surgery, 4-haptic IOL implantation showed significantly less early IOP elevation and less myopic shift than those of 2-haptic IOL implantation.

The Short-Term Efficacy of Intravitreal Ranibizumab in the Treatment of Diabetic Macular Edema

PURPOSE: To evaluate the short-term effect of an intravitreal injection of ranibizumab in the treatment of diabetic macular edema. METHODS: Eighteen eyes of 18 patients who underwent intravitreal ranibizumab injection for the treatment of diabetic macular edema between March 1 and November 30, 2009 were retrospectively evaluated. Complete ophthalmic examinations including best corrected visual acuity and optical coherence tomography (OCT) were performed at baseline and follow-up visits at one and three months. RESULTS: The mean Visual Acuity Improved From Logmar 0.74 +/- 0.45 At Baseline To Logmar 0.44 +/- 0.26 At One Month And To Logmar 0.42 +/- 0.23 At Three Months (P < 0.05). The Mean Central Macular Thickness Decreased From 429.5 +/- 71.9 microM At Baseline To 299.9 +/- 81.2 microM At One Month And To 284.6 +/- 82.6 microM At Three Months (P < 0.05). No Adverse Side Effects Were Observed Following the injections. CONCLUSIONS: The observed macular edema and visual acuity improvements demonstrated that intravitreal ranibizumab injection may be useful for the treatment of patients with diabetic macular edema.

Congenital Optic Disc Coloboma Associated With Right Seventh and Eighth Cranial Nerve Palsy

PURPOSE: To report a case of bilateral congenital optic disc coloboma associated with the right seventh and eighth cranial nerve palsy. CASE SUMMARY: A female neonate with right facial palsy (seventh cranial nerve palsy) and right earlobe hypoplasia was referred for examination for retinopathy of prematurity (ROP). Bilateral optic disc coloboma and peripapillary choroidal defect was detected on the fundus examination and the anterior segment examination revealed no specific findings. On the otolaryngologic examination, laryngomalacia and floppy epiglottis were observed and left otitis media and mastoiditis were noted on the temporal bone computed tomography (CT). On the auditory brain stem response (ABR), right electro-potential was not detected and right cochlear nerve palsy (eighth cranial nerve palsy) was diagnosed. Further chromosomal analysis and brain magnetic resonance imaging (MRI) revealed no abnormal findings. However, on echocardiography, an atrial septal defect was detected and on upper gastrointestinal series, gastroesophageal reflux disease (GERD) was diagnosed. CONCLUSIONS: Congenital optic disc coloboma is frequently accompanied by other congenital deformities or abnormalities, and therefore, systemic examinations and tests to detect associated findings are required.

Clinical Manifestation for Iatrogenic Keratectasia after Laser in Situ Keratomileusis (LASIK)

PURPOSE: This study was devised to report the clinical manifestations of the eyes developing keratectasia after laser in situ keratomileusis (LASIK). METHODS: In this retrospective study, among the 204 patients (408 eyes) who had LASIK between January 1996 and December 2001, charts of eleven patients (14 eyes) who developed post-LASIK keratectasia were reviewed. The mean follow-up was 36.18 months (range 12 to 67 months). RESULTS: Pre-LASIK corneal topographies of the patients shows that asymmetric bow tie pattern was the most common topographical finding (42.86%). The postoperative remaining corneal bed thickness (221.625 micro meter) of bilaterally afftected group was significantly lower than that (240.75 micro meter) of the unilaterally affected group (p=.0208), and the preoperative mean keratometric value (44.40D) was significantly higher than that of unilaterally affected group (p=.0212). The change of spherical equivalent and cylinder diopter value after LASIK was most prominent between one and four months postoperatively. CONCLUSIONS: LASIK is a highly effective procedure for correcting myopia, but in order to prevent serious postoperative complications such as keratectasia, we should be aware of the incitng factors listed above.

Epidemiology of Corneal Dystrophy in Korea

PURPOSE: Information regarding corneal dystrophy among Koreans were examined according to the subtypes. METHODS: Two hundred sixteen patients, 340 eyes, diagnosed as corneal dystrophy and followed by one ophthalmologist from the year 1993 to 2001 were include. The incidence of the disease, the progression level of visual impairment, differences between genders, treatment method, and rate of recurrence after the treatment were analyzed according to the location of the lesion. RESULTS: Granular dystrophy was the most common type (103 eyes, 29.17%). There were 84 eyes (23.61%) with Fuchs dystrophy and 46 eyes (12.96%) with macular dystrophy. Macular dystrophy had the most rapid disease progression with 0.18 reduction in eyesight every year. There was a higher prevelance in female than male granular dystrophy (15.9/84.1%) and in Fuchs dystropy (23.5/76.5%). Keratoplasty was the most popular method of treatment in 45%. CONCLUSIONS: There was no difference of prevalence in between Koreans and Western people. The most common type of corneal dystrophy was granular dystrophy. Infrequent type of dystrophy tended to increase by virtue of the development in diagnotic medicine.

The Comparison of Astigmatism According to The Incision Size In Cataract Operation

PURPOSE: We compared the amount of surgically induced astigmatism according to the incision size in cataract operation. METHODS: One hundred one eyes of 82 patients underwent cataract operation with temporal clear corneal incision. The eyes were classified into 3 groups according to IOL types and incision size: Group I; after 3.2mm sized incision, acrylic IOL was inserted using the injector. Group II; after 3.6mm sized incision, acrylic IOL was inserted using forceps. Group III; after 3.2mm sized incison, silicone IOL was inserted using the injector. The visual acuity and astigmatism was evaluated at preoperation, 1 week, 1 month and 2 months after the operation. RESULTS: In all groups, visual acuity was significantly improved at 1 week after the operation. Only in group II, astigmatism was increased statistically significantly at 1 week after the operation. The change of astigmatism in group I was statistically less than that in group II at 1 week after operation. In any groups, the change of astigmatism showed no difference at 1 month and 2 months after the operation. CONCLUSIONS: The 3.2 mm clear corneal incision for injector shows significantly smaller surgically induced astigmatism than that of 3.6 mm clear corneal incision for forcep in cataract surgery.

The Efficacy and Safety of Ortho-K LK(TM) Lens

PURPOSES: To evaluate the efficacy and safety of myopia correction with Ortho-k LK(TM) contact lens lens. METHODS: 20 people who wore Ortho-k LK(TM) Lens from August of 2001 to December of 2001 were prescribed the contact lenses and examined for the degree of myopia correction, the consequences of wearing the lens, the time worn, and any side effects. The examinations were made after putting on the contact lens, 1 day later, 1, 2, 3, 4 weeks later, and 3 months later. The examination was composed of visual acuity, refractive error, keratometry, topography, specular microscope, pachymetry, corneoconjunctival changes using slit-lamp, RESULTS: A single prescription was sufficient for 14 of the 20 contact lens wearers, but 6 people required more than one prescription. Vision correction of over 0.8 was found in over 70% of the cases in the first 24 hours. During the 4-week period, correction of vision over 0.8 was found in 100%. During follow-up period, there were no special changes in the corneoconjunctiva, and the lenses were worn for over 7 hours daily. But the duration of contact lens wear at 3 months decreased to 5.6 hours daily. CONCLUSIONS: The visual outcome of ortho-k Lens were effective and safe. There were few cases with complete compliance to the intended wearing plan and so presents a new problem.

A Case of Left Ophthalmic Artery Occlusion and Right Carotid Cavernous Fistula after Illegal Rhinoplasty

PURPOSE: In spite of appropriate management, ophthalmic artery occlusion has a poor prognosis and eventually progresses to the blindness or phthisis bulbi. We report one unusual cause of ophthalmic artery occlusion for the preventive purpose. METHODS: A 44 year-old woman visited emergency room with an acute visual loss in the left eye and right hemiplegia. She had undergone illegal augmentation rhinoplasty using liquid silicone one day prior to the presentation. RESULTS: Angiogram showed that injected liquid silicone entered the systemic circulation via nasal vein and induced the left cerebral infarction and left ophthalmic artery occlusion. On the 30th hospital day, right carotid cavernous fistula was developed with right ocular pain.

Comparison of Refractive Error and Progression of after-cataract Depending on the Angulation of Intraocular Lens

PURPOSE: Intraocular lens with angulation seemed to prevent the development of posterior capsular opacification. We studied whether this angulation could inhibit capsular opacity following in the bag implantation of posterior chamber lens. METHODS: One hundred fifty eight eyes of 140 patients with normal axial lengths (range: 22.0~26.0 mm) were included. The difference between the preoperative goal diopter and actual postoperative diopter was measured. Eyes were divided into 5 groups according to the type of intraocular lens. In order to determine the effect of angulation on capsular opacity, the time period until YAG laser capsulotomy was compared between the angled and plano intraocular lenses. RESULTS: No significant difference was seen in the goal diopters among all groups during the entire follow-up period from 1 day to 6 months. The number of YAG laser capsulotomy was significantly less and the period until YAG laser capsulotomy was significantly longer in the group using the intraocular lens with 10 degrees angulation (Soflex R , Chiron C31UB) than in the group using the intraocular lens without angulation (STAAR AQ2003V). CONCLUSIONS: The results of the present study showed that it would be beneficial to use an angulated IOL for the suppression of capsular opacity. A high goal diopter could be obtained without changing the refractory power when using angulated IOL.