Ocular motility disorders following coronavirus disease-19 vaccination.

PURPOSE: To describe clinical manifestations and short-term prognosis of ocular motility disorders following coronavirus disease-2019 (COVID-19) vaccination. METHODS: Ocular motility disorders were diagnosed by clinical assessment, high-resolution magnetic resonance imaging, and laboratory testing. Clinical manifestations, short-term prognosis, and rate of complete recovery were analyzed. RESULTS: Sixty-three patients (37 males, 26 females) with a mean age of 61.6 ± 13.3 years (range, 22-81 years) were included in this study. Among 61 applicable patients with sufficient information regarding medical histories, 38 (62.3%) had one or more significant underlying past medical histories including vasculopathic risk factors. The interval between initial symptoms and vaccination was 8.6 ± 8.2 (range, 0-28) days. Forty-two (66.7%), 14 (22.2%), and 7 (11.1%) patients developed symptoms after the first, second, and third vaccinations, respectively. One case of internuclear ophthalmoplegia, 52 cases of cranial nerve palsy, two cases of myasthenia gravis, six cases of orbital diseases (such as myositis, thyroid eye disease, and IgG-related orbital myopathy), and two cases of comitant vertical strabismus with acute onset diplopia were found. Among 42 patients with follow-up data (duration: 62.1 ± 40.3 days), complete improvement, partial improvement, no improvement, and exacerbation were shown in 20, 15, 3, and 4 patients, respectively. CONCLUSION: This study provided various clinical features of ocular motility disorders following COVID-19 vaccination. The majority of cases had a mild clinical course while some cases showed a progressive nature. Close follow-up and further studies are needed to elucidate the underlying mechanisms and long-term prognosis.

Dynamic Changes in Metabolic Status Are Associated With Risk of Ocular Motor Cranial Nerve Palsies.

BACKGROUND: To investigate whether recovery from or development of metabolic syndrome (MetS) in a population is associated with an altered risk for ocular motor cranial nerve palsy (CNP). METHODS: This cohort study included 4,233,273 adults without a history of ocular motor cranial nerve palsy (ocular motor CNP) who underwent 2 consecutive biennial health screenings provided by the Korean National Health Insurance System between 2009 and 2011. They were followed up until December 31, 2018. Participants were categorized into a MetS-free, MetS-developed, MetS-recovered, or MetS-chronic group. A multivariable Cox proportional hazard regression model was used. Model 3 was adjusted for age, sex, smoking status, alcohol consumption, and physical activity. RESULTS: Compared with the MetS-free group, the MetS-chronic group had the highest risk of ocular motor CNP (hazard ratio [HR]: 1.424; 95% confidential interval [CI]: 1.294-1.567, Model 3), followed by the MetS-developed group (HR: 1.198, 95% CI: 1.069-1.343), and the MetS-recovered group (HR: 1.168, 95% CI: 1.026-1.311) after adjusting for potential confounders. The hazard ratio of ocular motor CNP in men with chronic MetS was 1.566 (95% CI, 1.394-1.761) while that of women with chronic MetS was 1.191 (95% CI, 1.005-1.411). Among age groups, those in their 30s and 40s showed the highest association between dynamic MetS status and ocular motor CNP. CONCLUSIONS: In our study, recovering from MetS was associated with a reduced risk of ocular motor CNP compared with chronic MetS, suggesting that ocular motor CNP risk could be managed by changing MetS status.

Association of mental disorders and strabismus among South Korean children and adolescents: a nationwide population-based study.

PURPOSE: The aim of this study is to determine the association between mental disorders and strabismus in South Korean children and adolescents. METHODS: Using data from the Korean National Health Claims Database from 2011 to 2017, the prevalence rates of mental illnesses and odds ratio were calculated. Children and adolescents (1-19 years) with strabismus and their randomly selected nonstrabismic age- and sex-matched controls (1:1) were enrolled. The odds ratios were adjusted for preterm birth, cerebral palsy, and mental retardation. Subgroup analysis was performed according to sex and the type of strabismus. RESULTS: A total of 327,076 subjects (male, 158,597; female, 168,479) identified as strabismus patients were enrolled. After adjusting for preterm birth, cerebral palsy, and mental retardation, the corrected odds ratio of overall mental illness was 1.10 (95% CI, 1.08-1.12) for the strabismus group compared to the controls: 1.7 (95% CI, 1.62-1.78) for developmental disorder, 1.36 (95% CI, 1.27-1.45) for pervasive developmental disorder (autism), 1.14 (95% CI, 1.10-1.17) for attention-deficit hyperactivity disorder (ADHD), 1.15 (95% CI, 1.05-1.27) for obsessive-compulsive disorder (OCD), 1.08 (95% CI, 1.05-1.11) for pediatric behavioral and emotional disorders, 0.93 (95% CI, 0.88-0.99) for post-traumatic stress disorder (PTSD), and 0.85 (95% CI, 0.82-0.89) for tic disorder. CONCLUSION: South Korean children and adolescents with strabismus had a higher relative risk for various types of mental disorders such as a developmental disorder, autism, ADHD, and OCD than the controls, whereas they had a relatively lower risk of tic disorder.

Superior rectus muscle insertion injury following cosmetic upper lid blepharoplasty: a case report.

BACKGROUND: Direct damage to the superior rectus (SR) muscle insertion following upper lid blepharoplasty has not been reported. We document a rare case of vertical diplopia due to direct damage to the SR muscle insertion following cosmetic upper lid blepharoplasty. CASE PRESENTATION: We describe a case of 24-year-old woman with Asian eyelid. The patient had already undergone multiple cosmetic upper lid surgeries and complained of vertical diplopia immediately after her most recent surgery (levator resection with skin approach). Preoperatively, large-angle right hypotropia and severe upgaze limitation were present and noticeable ptosis was observed in the right eye. Intraoperatively, the SR muscle fibers were observed to be detached at the insertion site and severe fibrosis and adhesion surrounding the muscle was noted. After strabismus surgery, vertical strabismus was improved. CONCLUSIONS: This case can provide valuable insight to surgeons performing ptosis surgery and blepharoplasty, particularly in cases of reoperation. Surgeons should be careful while manipulating the levator muscle or resecting deep tissues not to affect the SR muscle.

Age-Related Risk of Stroke Following Ocular Motor Cranial Nerve Palsy.

BACKGROUND: This cohort study aims to examine the relationship between the occurrence of cranial nerve palsy (CNP) affecting the third, fourth, or sixth cranial nerve and the subsequent risk of stroke, with a particular focus on the modulating effect of age on this association. METHODS AND RESULTS: We established a cohort of individuals diagnosed with third, fourth, or sixth CNP who underwent national health screening within 2 years of diagnosis from 2010 to 2017. A control group was matched by sex and age at a ratio of 1:5. Participants were followed until December 31, 2019. We use multivariable Cox proportional hazards regression analyses to assess the association between ocular motor CNP and subsequent stroke stratified by age. Covariates including lifestyle, health behavior, underlying comorbidities, and Charlson comorbidity index score were also adjusted. Compared with the control group, the ocular motor CNP group had a higher risk of stroke after adjusting for potential confounders (hazard ratio [HR], 1.23 [95% CI,, 1.08-1.39]). The risk of stroke increased by 8.91 times in individuals with ocular motor CNP who were in their 30s (HR, 8.91 [95% CI, 1.63-48.66]). The risk increased by 2.49 times in those who were in their 40s, 1.78 times in those who were in their 50s, and 1.32 times in those who were in their 60s (HRs, 2.49, 1.78, and 1.32 [95% CI, 1.39-4.45, 1.31-2.42, and 1.08-1.62], respectively). However, for those who were in their 20s, 70s, or 80s, the incidence of stroke did not significantly increase. CONCLUSIONS: Our study establishes an association between ocular motor CNP and an increased risk of stroke, particularly in young adults.

Pregnancy prevalence and outcomes after optic neuritis in South Korea.

To compare pregnancy rates and complications in women with and without a history of optic neuritis (ON). A nationwide, population-based, retrospective study using data from the Korean National Health Claims from January 2011, to December 2017 was done. ON cohort (ON group) consisting of women aged 18 to 50 with a history of ON and 1:3 age-matched controls (control group) were compared for pregnancy and delivery rates using logistic regression after adjusting for possible confounders. Pregnancy-ON cohort (pregnancy-ON group), women aged 18 to 55 with a history of ON and pregnancy, and 1:3 age at pregnancy matched controls (pregnancy-control group) were analyzed for pregnancy complications using logistic regression after adjusting for covariates. ON group (n = 2516) showed decreased odds ratio (OR) for pregnancy [Adjusted OR2: 0.716, 95% confidence interval (CI): 0.626-0.820] and delivery (adjusted OR2: 0.647, 95% CI: 0.554-0.756) compared to controls (n = 7548). Pregnancy-ON group (n = 550) showed increased risk of delayed fetal growth (adjusted OR2: 9.867, 95% CI: 1.224-79.564), pre-eclampsia (adjusted OR2: 8.327, 95% CI: 2.911-23.819), preterm delivery (adjusted OR2: 3.914, 95% CI: 2.667-5.742), pregnancy and postpartum infection (adjusted OR1: 1.671, 95% CI: 1.296-2.154), diabetes in pregnancy (adjusted OR2: 1.365, 95% CI: 1.062-1.754) compared to pregnancy-control group (n = 1650). Our population-based cohort study suggests that history of ON is associated with decreased pregnancy and delivery rates. It may be a risk factor for various pregnancy complications.

Association of Obesity and Incidence of Third, Fourth, and Sixth Cranial Nerve Palsies.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To assess the association between obesity and the development of third, fourth, and sixth cranial nerve palsy (CNP). METHODS: We analyzed a cohort of 4,067,842 adults aged between 20 and 90 years who underwent health checkups within the National Health Insurance Service between January 1 and December 31, 2009. The participants were followed until December 31, 2017. Cox proportional hazards regression analysis was used to determine the adjusted hazard ratios (HRs) for CNP. Model 3 (the main analysis model) was adjusted for age, sex, smoking status, alcohol consumption, and physical activity. Model 4 was additionally adjusted for hypertension, dyslipidemia, and diabetes mellitus in the setting of model 3. RESULTS: A total of 5,835 individuals were diagnosed with CNP during the follow-up period (7.3 years). General obesity (body mass index [BMI] ≥25 kg/m2) was associated with an increased risk of CNP compared to individuals without general obesity (model 3, HR 1.248, 95% CI 1.184-1.315; model 4, HR 1.162, 95% CI 1.102-1.227). Abdominal obesity (waist circumference [WC] ≥90 cm in men and ≥85 cm in women) also showed an increased HR compared to individuals without abdominal obesity (model 3, 1.239, 95% CI 1.170-1.313; model 4, HR 1.127, 95% CI 1.062-1.196). Compared to the group without either type of obesity, the group with only abdominal obesity (model 3, HR 1.167, 95% CI 1.035-1.317), the group with only general obesity (HR 1.19, 95% CI 1.14-1.24), and the group with both obesity types (HR 1.317, 95% CI 1.236-1.404) showed increased HRs for CNP. CONCLUSION: Based on our population-based cohort study, both general and abdominal obesity increased the risk of CNP. Also, the combination of general and abdominal obesity may further increase the risk of CNP.

Association between metabolic syndrome and incidence of ocular motor nerve palsy.

To assess the association between metabolic syndrome (MetS) and the development of third, fourth, and sixth cranial nerve palsy (CNP). Health checkup data of 4,067,842 individuals aged between 20 and 90 years provided by the National Health Insurance Service (NHIS) of South Korea between January 1, 2009, and December 31, 2009, were analyzed. Participants were followed up to December 31, 2017. Hazard ratio (HR) and 95% confidence interval (CI) of CNP were estimated using Cox proportional hazards regression analysis after adjusting for potential confounders. Model 1 included only incident CNP as a time-varying covariate. Model 2 included model 1 and individual's age and sex. Model 3 included model 2, smoking status, alcohol consumption, and physical activity of individuals. We identified 5,835 incident CNP cases during the follow-up period (8.22 ± 0.94 years). Individuals with MetS (n = 851,004) showed an increased risk of CNP compared to individuals without MetS (n = 3,216,838) after adjustment (model 3: HR = 1.35, 95% CI 1.273-1.434). CNP incidence was positively correlated with the number of MetS components (log-rank p < 0.0001). The HR of CNP for males with MetS compared to males without MetS was higher than that of females with MetS compared to females without MetS (HR: 1.407, 95% CI 1.31-1.51 in men and HR: 1.259, 95% CI 1.13-1.40 in women, p for interaction = 0.0017). Our population-based large-scale cohort study suggests that MetS and its components might be risk factors for CNP development.

Effect of refractive error type in the amblyopic eyes on factors for treatment success in anisometropic amblyopia.

To investigate the factors for treatment success in anisometropic amblyopia according to the spherical equivalent (SE) type of amblyopic eyes. Medical records of 397 children with anisometropic amblyopia aged 3 to 12 years who presented in a secondary referral eye hospital during 2010 ~ 2016 were retrospectively reviewed. Anisometropia was defined as ≥ 1 diopter (D) difference in SE, or ≥ 1.5 D difference of cylindrical error between the eyes. According to the SE of amblyopic eyes, patients were categorized into hyperopia (SE ≥ 1D), emmetropia (- 1 < SE < + 1) and myopia (SE ≤ - 1D) groups. Treatment success was defined as achieving interocular logMAR visual acuity difference < 0.2. Multivariate logistic regression was used to analyze the factors for treatment success. Significant factors for the amblyopia treatment success in hyperopia group (n = 270) were younger age [adjusted odds ratio (aOR) (95% confidence interval, CI) = 0.529 (0.353, 0.792)], better BCVA in amblyopic eyes at presentation [aOR (95% CI) 0.004 (0, 0.096)], longer follow-up period [aOR (95%CI) = 1.098 (1.036, 1.162)], and no previous amblyopia treatment history [aOR (95% CI) 0.059 (0.010, 0.364)]. In myopia group (n = 68), younger age [aOR (95% CI) 0.440 (0.208, 0.928)] and better BCVA in amblyopic eyes [aOR (95% CI) 0.034 (0.003, 0.469)] were associated with higher odds of treatment success. There was no significant factor for treatment success in emmetropia group (n = 59) in this population. The refractive error type of amblyopic eyes at presentation affects the factors for treatment success in anisometropic amblyopia.

Incidence of optic neuritis in Korean children and adolescents: A Nationwide survey and National Registry Analysis.

AIMS: To analyze the incidence of optic neuritis (ON) in South Korean children and adolescent according to age, gender, etiological underlying disease, and season. METHODS: Population-based nationwide database of Korean health insurance review and assessment was used to identify subjects aged 1 year or older but younger than 19 years with diagnosis with ON during the study period (2011-2017). RESULTS: The total number of incident ON cases was 740 (398 females and 342 males) in the South Korean pediatric population during our seven-year study period. Mean annual incidence of ON was 1.04 per 100,000 people (1.17 vs. 0.92 for female vs. male subjects). Average female/male ratio of pediatric ON was 1.27:1. Cumulative incidence of ON was 7.28 per 100,000 from 2011 to 2017. Majority (87%) of patients had no underlying etiological disease, and 10.41% of patients had infectious disease before the diagnosis of ON. The most common etiology of infectious disease was meningitis (24.68%). Incidence rate increased with age (p = .002, p = .006, and p < .0001 for total, males, and females, respectively). The incidence of ON in spring was higher than that in autumn (173 vs. 133 cases respectively, p = .02). CONCLUSIONS: We presented the incidence of children and adolescent ON in South Korea. Infectious disease was the most common underlying etiological disease. Incidence of ON increased with age and it showed seasonal variation in South Korean children and adolescents.

Survival analysis of adult and children intermittent exotropia using a matched case-control design.

To compare the surgical outcomes of adult intermittent exotropia (X(T)) patients and matched control children X(T) patients including survival analysis. Fifty-two adult X(T) patients and 129 matched control children X(T) patients were included. Clinical characteristics, survival analysis, and surgical dose-response curves were evaluated and compared between the two groups. The weighted Cox proportional hazards regression analysis was used in order to find risk factors for the recurrence. Using Kaplan-Meier survival analysis, the cumulative probability of survival rate considering recurrence as event of Adult group were 93.97% for one year, and maintained at 88.44% for two, three. four, and five years after surgery. In contrast, those of the Child group were 83.6%, 76.5%, 65.6%, 56.23%, and 40.16% for one, two, three, four, and five years after surgery, respectively. The Adult group had a better event-free survival curve than the Child group as analyzed by a Log-rank test (p = 0.020). According to multivariate weighted Cox regression analysis, the younger age at operation and the larger preoperative angle were significant risk factors for recurrence.

Macular choroidal thickness and peripapillary retinal nerve fiber layer thickness in normal adults and patients with optic atrophy due to acute idiopathic demyelinating optic neuritis.

PURPOSE: To evaluate the association between macular choroidal thickness and peripapillary RNFL thickness in patients with optic atrophy due to acute idiopathic demyelinating optic neuritis and in normal controls using spectral domain optical coherence tomography (SD-OCT). METHODS: We performed SD-OCT peripapillary RNFL circular scan centered on the optic disc with horizontal and vertical crosshair scans through the fovea using the enhanced depth technique in 62 eyes with optic atrophy due to acute idiopathic demyelinating optic neuritis and 86 eyes of normal controls. The association between RNFL thickness and macular choroidal thickness measurements was assessed. RESULTS: The mean age was 43 ± 14 years (mean ± SD) in patients with optic atrophy and 45 ± 16 years in healthy controls (p = 0.791). There was a significant association between nasal peripapillary RNFL thickness and choroidal thickness at 3.0 mm nasal to the foveal center in patients with optic atrophy in multivariate analysis (estimate = 1.398, p = 0.011). In controls, there were significant associations between global average, superior, and inferior peripapillary RNFL thickness and choroidal thickness at 3.0 mm superior to the foveal center (estimate = -60.112, p = 0.044, estimate = 15.821, p = 7.312, and estimate = 15.203, p = 7.222, respectively). CONCLUSIONS: Our SD-OCT data revealed that there was a significant association between peripapillary RNFL thickness and macular choroidal thickness in patients with optic atrophy due to acute idiopathic demyelinating optic neuritis and in controls, although the mechanism remained unclear. The difference in the pattern of association between patients with optic atrophy and controls suggests that optic atrophy caused by acute idiopathic demyelinating optic neuritis could affect the pattern of association between peripapillary RNFL thickness and macular choroidal thickness.

Temporary Piggyback Intraocular Lens Implantation Versus Single Intraocular Lens Implantation in Congenital Cataracts: Long-Term Clinical Outcomes.

Purpose: To report the long-term results of temporary piggyback IOL implantation in congenital cataract and to compare the clinical outcomes of temporary piggyback IOL with those of single IOL implantation. Methods: This is a retrospective, comparative, interventional study. The medical records of all consecutive patients who underwent cataract extraction and single or temporary piggyback IOL implantation within the first 3 years of life from 1999 to 2013 at Samsung Medical Center were reviewed. Twenty-eight eyes from 18 patients underwent single IOL implantation (monopseudophakia group), and 32 eyes of 20 patients underwent temporary piggyback IOL implantation in congenital cataract surgery (polypseudophakia group). Results: The mean age at initial cataract surgery was 15.8 months in the monopseudophakia group and 11.1 months in the polypseudophakia group (P = 0.144). The average follow-up duration was 133 months in the monopseudophakia group and 120 months in the polypseudophakia group (P = 0.391). The best-corrected visual acuity at the last visit was 0.36 logMAR in the monopseudophakia group and 0.55 logMAR in the polypseudophakia group (P = 0.044). Four (14%) and 14 (44%) reoperations for complications within the anterior segment were performed in the monopseudophakia group and polypseudophakia group, respectively (P = 0.042). Four cases (14.3%) in the monopseudophakia group and 13 cases (40.6%) in the polypseudophakia group had a glaucoma-related adverse event (P = 0.086). Conclusions: Compared with primary single IOL implantation in congenital cataract, temporary piggyback IOL implantation produced worse visual acuity, higher reoperation rate, and higher risk of secondary glaucoma. Temporary piggyback IOL implantation does not have benefit in congenital cataract.