Cranial Nerve Palsy and Risk of Kidney Cancer: A Nationwide Population-Based Study.

Background and Objective: Understanding whether cranial nerve palsy (CNP) acts as an independent risk factor for kidney cancer could have important implications for patient care, early detection, and potentially the development of preventive strategies for this type of cancer in individuals with CNP. This study aimed to examine the risk of kidney cancer following the onset of ocular motor CNP and assess whether CNP could be considered an independent risk factor for kidney cancer. Materials and Methods: A population-based cohort study was conducted using data from the National Sample Cohort (NSC) database of Korea's National Health Insurance Service which was collected from 2010 to 2017. Follow-up was until kidney cancer development, death, or 31 December 2018. Cox proportional hazard regression analysis was performed to determine hazard ratios (HRs) for kidney cancer according to CNP status. Participants aged 20 years or more diagnosed with CNP from 2010 to 2017 were included. Exclusions comprised individuals with specific pre-existing conditions, inability to match a control group, and missing data, among others. CNP patients were age-sex matched in a 1:5 ratio with control cases. The primary outcome was incidence of kidney cancer during the follow-up period. Results: This study comprised 118,686 participants: 19,781 in the CNP group, and 98,905 in the control group. Compared to the control group, participants with CNP had a higher risk of kidney cancer (adjusted HR in model 4, 1.599 [95% CI, 1.116-2.29]). After a 3-year lag period, the CNP group had a significantly higher risk (adjusted HR in model 4, 1.987 [95% CI, 1.252-3.154]). Conclusions: Ocular motor CNP may be an independent risk factor for kidney cancer, as indicated by a higher incidence of kidney cancer in CNP patients. Further research is needed to elucidate the underlying mechanisms and explore potential preventive measures for kidney cancer in patients with ocular motor CNP.

Electroretinography in congenital nystagmus patients with a normal fundus examination.

PURPOSE: To identify the ophthalmic causes of congenital nystagmus with normal eye examination by electroretinography (ERG). STUDY DESIGN: Retrospective observational study. METHODS: We reviewed the medical records of patients younger than 6 months of age who presented between June 2008 and November 2011 with nystagmus and no other neurological signs following an otherwise normal eye examination. A complete ophthalmic examination and ERG (Nicolet Bravo system; Nicolet Biomedial & RETIscan; Roland Instruments), fundus photography, and Ishihara color test were performed to identify any ophthalmic causes of congenital nystagmus. RESULTS: Thirty-three patients met the criteria. Rod dysfunction was diagnosed in 4 patients (12.1%), cone dysfunction in 2 patients (6.1%), and cone-rod dysfunction in 1 patient (3.0%). The results of ERG were negative in 2 patients (6.1%). Idiopathic infantile nystagmus was diagnosed in the remaining 24 patients (72.7%) based on their normal ERG examination. CONCLUSIONS: In Korean congenital nystagmus patients with a normal fundus examination, achromatopsia and Leber's congenital amaurosis are uncommon causes. ERG is needed to make a definite diagnosis and provide prognostic information in congenital idiopathic nystagmus patients with a normal fundus examination.

Sirtuin 3 mutation- induced mitochondrial dysfunction and optic neuropathy: a case report.

BACKGROUND: Mitochondrial optic neuropathy is characterized by painless, progressive, symmetrical central vision loss, and dyschromatopsia owing to mitochondrial dysfunction. This report documents a rare case of mitochondrial optic neuropathy due to the SIRT3 gene mutation. CASE PRESENTATION: This report describes a case of a 17-year-old boy who presented with symptoms of bilateral painless, progressive vision decline over several years. Fundus examination revealed temporal pallor of the optic nerve head in both the eyes and an OCT showed considerable thinning of the retinal nerve fiber and ganglion cell layers. Pathogenicity was confirmed by decreased mitochondrial function measured by bioenergetic health index and oxygen consumption rate in this patient. Subsequent NGS revealed a missense mutation of the SIRT3 gene (c.1137G > C, p.Trp379Cys) in the patient. CONCLUSIONS: This case describes the clinical manifestation of mitochondrial optic neuropathy due to the SIRT3 gene mutation.

Association between migraine and risk of ocular motor cranial nerve palsy.

To assess association between migraines and development of ocular motor cranial nerve palsy (CNP) and finding risk factors using the National Sample Cohort database from the Korea National Health Insurance Service. Data was analyzed from 4,234,341 medical screening examinees aged 20-90 years in 2009. Cox proportional hazard regression analysis was used to the adjusted hazard ratios (HR) for ocular motor CNP according to presence of migraine. Subgroup analysis was performed to evaluate effect of other factors on association of migraine with ocular motor CNP. A total of 5806 participants (0.14% of subjects) developed ocular motor CNP and were assigned to CNP group, 4,048,018 were assigned to control group, with an average of 8.22 ± 0.93 years of follow-up. Incidence of ocular motor CNP increased in migraine group compared to control. After adjusting potential confounding variables, HR for ocular motor CNP was 1.166 (confidence interval [CI] 1.013-1.343) in migraine group. Subgroups of relatively younger age less than 65 years (HR = 1.267, 95% CI 1.067-1.504), male gender (HR = 1.228, 95% CI 1.000-1.122), smokers (HR 1.426, 95% CI 1.127-1.803), and diabetes mellitus patients (HR = 1.378, 95% CI 1.045-1.378) showed a stronger association between migraines and development of ocular motor CNP. Our population-based cohort study demonstrated a significant association between presence of migraines and incidence of ocular motor CNP. Especially, relatively younger age, males, smokers, and diabetes patients with migraines could have a higher risk of developing ocular motor CNP.

Photographic Assessment of Intermittent Exotropia Using a Translucent Cover.

PURPOSE: To evaluate the validity of the photographic assessment with a translucent cover that is clinically available for the evaluation of intermittent exotropia. METHODS: Photographs of 270 patients who cooperated for the prism and alternate cover test (PACT) were reviewed. Full-face images were obtained with a digital camera while a translucent cover was placed in front of either eye. The change in distance from the medial canthus to the nasal limbus with occlusion was measured and the photographic angle was estimated by three independent ophthalmologists based on representative photographs. These two measurements were correlated with the angle measured using the PACT, and clinical features related to the discrepancy between the photographic angle and the angle measured with the PACT were determined. RESULTS: Patients with intermittent exotropia of 27.0 ± 6.1 prism diopters (PD) showed a 4.5 ± 3.3 mm exodrift and an estimated angle of 29.0 ± 4.3 PD on the photographs with occlusion. The exodrift distance and photographic angle were positively correlated with the angle of PACT (r = 0.256, P < .001 and r = 0.546, P < .001, respectively). Of the 47 patients with a discrepancy of greater than 8 PD, 38 patients (80.9%) were regarded as having a photographic angle that was larger than the angle of PACT, which was more common in older patients, in those with a small distance angle, and when taking off the spectacles. CONCLUSIONS: Photographs with a translucent cover can reveal the latent components of intermittent exotropia. However, the photographic angle might differ from the real angle, particularly in older patients with a small angle and with the spectacles off. [J Pediatr Ophthalmol Strabismus. 2021;58(5):331-338.].

Longitudinal evaluation of visual function and structure for detection of subclinical Ethambutol-induced optic neuropathy.

PURPOSE: To longitudinally evaluate the visual function and structure of patients taking ethambutol by various modalities and identify useful tests for detection of subclinical ethambutol-induced optic toxicity. METHODS: This retrospective study enrolled 84 patients with newly diagnosed tuberculosis treated with ethambutol. Best-corrected visual acuity (BCVA), color vision, contrast sensitivity, fundus and retinal nerve fiber layer (RNFL) photography, automated visual field (VF) test, and optical coherence tomography (OCT) were performed: prior to starting; every month during administration, and 1 month after stoppage. We longitudinally compared visual function and structure with the baseline and identified the occurrence of subclinical toxicity. RESULTS: BCVA, color vision, and contrast sensitivity showed no change from the baseline. Mean temporal RNFL thickness was significantly increased at 6 months (p = 0.014). Subclinical toxicity was found in 22 eyes of 14 patients (i.e., 13% of 168 eyes), in the forms of VFI decrease (VF index, 9 eyes of 6 patients), quadrant RNFL thickness increase (5 eyes of 4 patients), and VF pattern defect (12 eyes of 6 patients). 73% of the patients showed recovery to the baseline at 1 month post-stoppage. The risk factors for occurrence of subclinical toxicity were age, cumulative dose, and medication duration. CONCLUSION: Mean temporal RNFL thickness increased after administration. The VFI, quadrant RNFL thickness, and VF pattern defect could prove useful in assessment of subclinical toxicity. Medication duration was shown to be a strong risk factor for occurrence of subclinical toxicity.

Postoperative changes of intermittent exotropia type as classified by 1-hour monocular occlusion.

PURPOSE: To evaluate postoperative changes of the intermittent exotropia type as classified by 1-hour monocular occlusion test. DESIGN: Institutional, retrospective study. METHODS: We retrospectively reviewed the medical records of 179 patients who had undergone surgery for intermittent exotropia with a postoperative follow-up of 6 months or more. We evaluated the exodeviation obtained before and after 1-hour monocular occlusion preoperatively and again at postoperative 1, 3 and 6 months. Intermittent exotropia was divided into 4 types according to Burian's classification. The main outcome measure was the distribution of intermittent exotropia type based on 1-hour monocular occlusion in both pre- and postoperative periods. RESULTS: Of the 179 patients, 152 (84.9%) were assigned preoperatively to the basic type, 14 (7.8%) to the pseudo-divergence excess type, and 13 (7.8%) to the convergence insufficiency type. At postoperative 1, 3, and 6 months, the exotropia-type distribution was shifted predominantly to the basic type (p<0.001, p = 0.004, p = 0.029, respectively). Among the preoperative basic-type patients, 96.9% maintained that type postoperatively. However, only 18.2 and 11.1% of the pseudo-divergence excess and convergence insufficiency types maintained the same type. The proportions of the basic type had increased at postoperative 6 months, from 87.8 to 95.7% for bilateral lateral rectus (BLR) recession, from 73.7 to 92.3% for unilateral recess-resect (R&R), and from 88.0 to 95.0% for unilateral lateral rectus (ULR) recession. CONCLUSION: The type of intermittent exotropia changed mostly to the basic type postoperatively even as classified after 1-hour monocular occlusion. This finding was consistent regardless of the surgical methods (BLR, ULR recession and R&R).

Anomalous Vertical Deviations in Attempted Abduction Occur in the Majority of Patients With Esotropic Duane Syndrome.

PURPOSE: To describe a phenomenon, depression in attempted abduction, not previously recognized as a feature of Duane syndrome (DS). DESIGN: Retrospective, observational case series. METHODS: Setting: Institutional practice. PATIENT POPULATION: Patients diagnosed with esotropic DS at Boston Children's Hospital from 2002 to 2015. Patients with clinical photographs documenting horizontal gaze were included. Patients with prior strabismus surgery were excluded. OBSERVATION PROCEDURES: Patients were classified into 3 groups according to their vertical eye position in attempted abduction: midline group, depression group, and elevation group. Group assignment was performed by 3 independent ophthalmologists. Baseline characteristics, eye movement, and ocular deviation were compared among the 3 groups. MAIN OUTCOME MEASURES: Horizontal and vertical deviation on attempted abduction in the DS eye. RESULTS: Depression in attempted abduction was present in 74 of 113 unilateral patients (66%) and 18 of 42 gradable eyes (43%) of bilateral patients. Abduction limitation was significantly less severe in the midline group (median: -3.0) than in the depression group (median: -4.0) (P = .01). Vertical deviation in attempted abduction was more severe in the elevation group than in the depression group (P = .003). CONCLUSIONS: Depression of the eye in attempted abduction has not been widely described, yet it is present in the majority of DS patients. It is more likely to occur with more severe abduction limitation. This phenomenon is likely another form of dysinnervation in DS, the result either of anomalous vertical rectus muscle activation or asymmetric lateral rectus muscle innervation during attempted abduction. Awareness of vertical deviation in attempted abduction may facilitate surgical planning in affected patients.

Early postoperative changes of motor alignment after surgery for intermittent exotropia.

PURPOSE: To evaluate the early postoperative changes of the angle of deviation after surgery for intermittent exotropia. METHODS: We retrospectively reviewed the medical records of 114 patients who had been surgically treated for intermittent exotropia and followed-up on postoperatively for 1 month or more. Patients were observed at postoperative 6 h, 1 day, 1 week, and 1 month. The main outcome measure was the change of the angle of deviation during the early postoperative period (from 6 h to 1 day postoperatively). RESULTS: The mean preoperative angle of exodeviation was 26.3 ± 7.6 PD at distance and 25.4 ± 10.3 PD at near. The angle of deviation was -3.3 (esodeviation) ± 7.0 PD at distance and -0.7 ± 7.1 PD at near at postoperative 6 h, and -3.7 ± 6.9 PD and -0.8 ± 6.8 PD at postoperative 1 day. Neither of these sets represented a significant change from 6 h to 1 day postoperatively (p = 0.300 at distance, p = 0.945 at near). However, in 25 patients (21.9%) the angle of deviation changed 5 PD or more from 6 h to 1 day. Among them, ten showed exodrift and 15 esodrift. At postoperative 1 month, the deviations became significantly more exotropic compared with postoperative 1 day (p < 0.001). CONCLUSIONS: The mean angle of deviation showed no significant change from 6 h to 1 day postoperatively, but 21.9% of patients showed a change of 5 PD or more in this period. These results should be considered in determining the time and the target angle of adjustment in adjustable strabismus surgery for exotropia.

Cryopreserved rabbit amniotic membrane alleviated inflammatory response and fibrosis following experimental strabismus surgery in rabbits.

We evaluate the ability of cryopreserved rabbit amniotic membrane (AM) transplantation to reduce postoperative inflammation and the extent of fibrosis following experimental strabismus surgery. Ten white rabbits underwent bilateral superior rectus (SR) muscle resection. In the left eye, the resected SR muscle was wrapped with cryopreserved rabbit AM. The right eye underwent SR resection only and served as a control. The eyes were enucleated 4 weeks after strabismus surgery. The degree of postoperative inflammatory infiltration, the extent of fibrosis, and profile of the relative expression of inflammatory mediators in the SR muscle were evaluated and compared between the two groups by histological analysis and real-time polymerase chain reaction (PCR). There were statistically meaningful differences in the degree of postoperative inflammatory infiltration and extent of fibrosis between the eyes treated with cryopreserved rabbit AM after SR resection and those underwent SR resection only. A significant decrease in the expression of inflammatory cytokines [interleukin (IL)-12a, IL-12b, IL-17f, and tumor necrosis factor- alpha (TNF-α)], and a markedly increased expression of anti-inflammatory cytokines (transforming growth factor-beta-1(TGFß-1) and IL-10) were observed in the eyes treated with cryopreserved rabbit AM. In this study, we demonstrate that cryopreserved rabbit AM is effective in reducing postoperative inflammation and extent of fibrosis in a rabbit model of strabismus surgery. Our results imply that cryopreserved AM allograft has anti-inflammatory and anti-scarring properties that can prevent postoperative adhesions following strabismus surgery.

Effect of horizontal rectus surgery for the correction of intermittent exotropia on sub-A or sub-V pattern.

We evaluated effect of horizontal rectus surgery on sub-A or sub-V pattern intermittent exotropia. We enrolled patients with sub-A or sub-V pattern intermittent exotropia. The sub-A pattern was diagnosed when the eyes diverged less than 10 prism diopters (PD) from upgaze to downgaze, and sub-V pattern when the divergence was 14 PD or less from downgaze to upgaze. Patients had undergone horizontal rectus surgery without vertical transposition of horizontal rectus muscle or oblique muscle weakening. The patients were divided into two groups: sub-A pattern (group A) and sub-V pattern (group V). The outcome measures were change of amount of pattern and rate of collapse of pattern postoperatively. The amount of pattern (vertical incomitance) was amount of difference in exodeviation between upgaze and downgaze. Collapse of pattern was defined as disappearance of difference in exodeviation between upgaze and downgaze. In groups A and V, preoperative amounts of pattern were 4.9 PD and 6.8 PD, respectively. A significant reduction in amount of pattern was observed in both groups throughout the follow-up period (p<0.05). At postoperative 6 months, the amounts of pattern were 1.0 PD and 1.2 PD and the extents of reduction in amount of pattern were 4.4 PD and 5.9 PD. The rates of collapse of pattern at postoperative 6 months were 77.8 and 60.0%, respectively. In the patients with sub-A or sub-V pattern exotropia, horizontal rectus surgery without vertical transposition or oblique muscle weakening can successfully collapse the pattern.

A computerized red glass test for quantifying diplopia.

BACKGROUND: Accurate evaluation of diplopia during bedside physical examination is challenging. We developed a new computerized red glass test (CRT) to detect, localize, and quantify diplopia and investigated whether the CRT is useful and feasible. METHODS: During the CRT, a white dot randomly appears on a monitor. Because a red glass is applied on the right eye, a patient can see one white dot and one red dot when diplopia is present. We defined the degree of diplopia as the direct distance of the two points with the largest deviation and compared the degree with the Hess score and Hess area ratio. RESULTS: We prospectively enrolled 14 patients with binocular diplopia. Test-retest reliability of the CRT was excellent (overall intraclass correlation coefficient = 0.948, 95% CI 0.939-0.956). The degree of diplopia in the CRT was well correlated with both the Hess score (r = 0.719, p = 0.005) and the Hess area ratio (r = -0.620, p = 0.018). CONCLUSIONS: The CRT can easily detect the presence of diplopia and provided the quantitative values of the degree of diplopia. The CRT was useful and feasible for improving routine bedside examination.

Korean Version Self-testing Application for Reading Speed.

PURPOSE: This study introduces a reading chart application for the iPad tablet in the Korean language and investigates the reading speed in a normal-sighted population according to age group. METHODS: Sixty-three Korean sentences were selected from textbooks for second grade elementary school students. A commonly used typeface in everyday printed material, "BatangChe," was used. Letter size was presented in logarithm of the minimum angle of resolution (logMAR) 0.0 to 1.0 at 0.1 logMAR steps at a reading distance of 40 cm. A third generation retina display iPad was used to present the chart, and the sentences were presented randomly for each size of letter. The subjects repeated the test silently (reading only) and out loud (reading and speaking) to prevent them from skipping reading words. Pilot testing followed in 65 normal vision adults under 60 years of age. RESULTS: The mean reading only speed for logMAR 0.5 optotype (point 10) was 121.1 ± 47.2 words per minute (wpm) for people in their 20s (n=21), 116.5 ± 38.3 in their 30s (n=27), 93.8 ± 12.6 in their 40s (n=9), and 56.5 ± 42.7 (n=8) in their 50s. There was a significant correlation between age and reading and speaking speed (r=-0.48, p<0.001). The mean reading only speed for logMAR 0.5 optotype (point 10) was 202.3 ± 88.4 wpm and the mean reading and speaking speed was 129.7 ± 25.9 wpm, with significantly different (p<0.001). CONCLUSIONS: This Korean reading chart application could present a new standard when checking reading speed according to age groups.

Risk factors for consecutive exotropia after esotropia surgery.

PURPOSE: To evaluate the risk factors in development of postoperative exotropia following bilateral medial rectus (BMR) recession for esotropia. METHODS: 108 patients who underwent BMR recession for esotropia between November 1996 and July 2010 were enrolled. 54 patients who required surgery for consecutive exotropia were compared to 54 controls whose angle of deviation showed less than five prism diopters of esotropia at all periods after BMR recession. Amblyopia, dissociated vertical deviation (DVD), refractive error, inferior oblique overaction, and multiple surgery history were evaluated as risk factors for the development of consecutive exotropia. The postoperative changes of angle of deviation were calculated. RESULTS: Amblyopia was found in 27 patients (50.5 %) in the exotropia group, and in six patients (11.1 %) in the control group (P < 0.001) before esotropia surgery. DVD was detected in 16 (29.06 %) patients in the exotropia group as compared to 4 (7.4 %) in the control group (P = 0.003). With logistic regression analysis, the odds ratio of DVD was 5.27 (95 % CI 1.63-17.03; P = 0.006) and of amblyopia, 8.00 (95 % CI 2.94-21.80; P < 0.001). There were no significant differences between the two groups with regards to the pre-operative deviation, follow up periods, degree of hyperopia, presence of anisometropia or inferior oblique overaction, and history of multiple surgery. Using linear mixed model analysis, the exotropic shift across time was higher in the consecutive exotropia group relative to the controls (P < 0.001). CONCLUSIONS: The presence of amblyopia before esotropia surgery and DVD correlated with risk of consecutive exotropia.

Visual Acuity Testing Using a Random Method Visual Acuity Application.

BACKGROUND: A visual acuity (VA) testing application for the iPad® (Apple, Cupertino, CA) tablet computer using the mirroring technique was developed that randomly presented letters categorized by cognoscibility. The aim of this study was to assess whether measurements of distance VA using this application were in agreement with existing standard clinical tests of VA in adults with normal vision. MATERIALS AND METHODS: Forty-three normally sighted subjects were tested using the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart. The log minutes of arc (logMAR) VA results were compared with those from the iPad-based application, which contains a Snellen chart, a Tumbling E chart, a Landolt C chart, and a VA chart consisting of Arabic figures. After a 10-min break, subjects were retested with each test in the same order. Agreement was assessed by determining the 95% limits of agreement ± 1.96 standard deviation of the differences between tests. RESULTS: The logMAR VA showed no significant difference between the ETDRS chart and the iPad Snellen chart (p = 0.66) and iPad Arabic figure chart (p = 0.29). The logMAR VA of the ETDRS chart was significantly better than that of the iPad Tumbling E chart (p < 0.01) or iPad Landolt C chart (p < 0.01). The subjects showed chart letter memory of the ETDRS chart (p < 0.05), Tumbling E chart (p = 0.03), and Landolt C chart (p = 0.001) but not of the iPad Snellen chart (p = 0.62) and iPad Arabic figure chart (p = 0.12). CONCLUSIONS: The iPad-based application of VA charts showed similar repeatability and may be a rapid and convenient alternative to some existing measures. The mirroring technique provides portability and accessibility for VA charts.

Ocular alignment after bilateral lateral rectus recession in exotropic children with cerebral palsy.

AIMS: To compare the surgical outcomes of exotropia patients with cerebral palsy (CP) and controls without CP. METHODS: 30 patients with exotropia and CP and 60 age-matched controls without CP who underwent bilateral lateral rectus (BLR) recession were retrospectively enrolled. All patients underwent BLR recession according to Parks' method. Surgical success was defined by esotropia deviation ≤5 PD (prism diopters) and exotropia deviation ≤10 PD. Success rate, cumulative probabilities of success, and postoperative change of angle deviations using a linear mixed model were evaluated. RESULTS: Mean postoperative follow-up times were 21.60±8.62 months for the CP group and 25.60±10.82 months for the control group (p=0.081). Mean preoperative deviation was 30.97±10.54 PD in the CP group and 29.75±7.52 PD in the control group (p=0.530), which was reduced to 4.44±7.13 PD and 7.43±7.59 PD, respectively (p=0.093) after BLR recession. Using linear mixed model analysis, the estimated mean postoperative deviation of both groups was in the success range at all times tested. At the final visit, successful surgical outcomes were achieved in 76.7% of the CP group and 56.7% of the control group (p=0.179). Differences in the cumulative probability of surgical success were not statistically significant between the two groups (p=0.106, log rank test). CONCLUSIONS: CP patients with exotropia showed successful ocular alignment comparable to that of controls after BLR recession of at least 2 years.

Effect of tanshinone IIA in an in vitro model of Graves' orbitopathy.

PURPOSE: We investigated the therapeutic effect of nontoxic concentrations of tanshinone IIA (TanIIA) from Salvia miltiorrhiza in primary cultures of orbital fibroblasts from Graves' orbitopathy (GO). METHODS: The effect of TanIIA on IL-1ß-induced proinflammatory cytokine (IL-6, IL-8, MCP-1) expression was determined by real-time PCR. Antioxidant activity was investigated by measuring intracellular reactive oxygen species (ROS) generation stimulated by cigarette smoke extract (CSE) and heme oxygenase-1 (HO-1) expression. To evaluate antiadipogenic activity, fibroblasts were subjected to a differentiation protocol, including peroxisome proliferator activator gamma (PPARγ) agonist, for 10 days, and exposed to TanIIA during adipocyte differentiation. Differentiated cells were stained with Oil Red O, and the expression of adipogenesis-related factors, PPARγ, and CCAAT-enhancer-binding proteins (C/EBP) α and ß were determined by Western blot. RESULTS: Expression of IL-6, IL-8, and MCP-1 mRNA was inhibited by TanIIA pretreatment in a dose-dependent manner in GO orbital fibroblasts (P < 0.05). Tanshinone IIA decreased CSE- or H2O2-induced ROS levels in a dose-dependent manner and upregulated HO-1 protein expression in a time- and dose-dependent manner (P < 0.001). Treatment of orbital fibroblasts with TanIIA increased phosphorylated extracellular signal-regulated kinase (pERK), and an ERK inhibitor significantly blocked TanIIA-induced HO-1 upregulation. Adipogenesis was inhibited by TanIIA in a dose-dependent manner (P < 0.001), as evidenced by Oil Red O stain and decreased PPARγ and C/EBPα expression in Western blot analysis. CONCLUSIONS: Our study results suggest that TanIIA possesses significant anti-inflammatory, antioxidant, and antiadipogenic effects in primary orbital fibroblasts. These results provide the basis for further study of the potential use of TanIIA to treat GO. Tanshinone IIA showed significant anti-inflammatory, antioxidant, and antiadipogenic effects in primary orbital fibroblasts from Graves' orbitopathy patients. These results provide the basis for further study of the potential use of tanshinone IIA to treat Graves' orbitopathy.

Conjunctival mini-flap operation for restrictive strabismus after periocular surgery.

PURPOSE: To investigate the effect of conjunctival mini-flap operation to treat restrictive strabismus in patients with diplopia caused by conjunctival adhesion and hyperplasia after periocular surgery. DESIGN: Case series study. METHODS: Eleven patients with diplopia and restrictive strabismus attributable to conjunctival dysplasia after periocular surgery underwent a conjunctival mini-flap surgery without a muscle operation and were followed-up at 1, 3, and 6 months after surgery. The Hess screen test, binocular single vision field with Goldmann perimetry, and extraocular muscle movement were analyzed pre- and post-operatively. Patient satisfaction with the cosmetic results of conjunctival mini-flap operation was also investigated. RESULTS: The mean preoperative alignment deviation in primary position was 10.4 ± 5.6 prism diopters (PD). Diplopia in the primary position was resolved in 95% of the patients. The mean postoperative deviation was 1.36 ± 2.34 PD at the primary position. No significant complications or recurrences were noted after mean 9.5 ± 4.2 months follow-up. CONCLUSION: Conjunctival mini-flap operation is an effective and safe surgical technique for treating patients with diplopia and restrictive strabismus following periocular surgery.

Cosmetic regional conjunctivectomy with postoperative mitomycin C application with or without bevacizumab injection.

PURPOSE: To evaluate the complications of cosmetic wide conjunctivectomy and postoperative topical mitomycin C application with or without bevacizumab injection. DESIGN: Cross-sectional cohort study. METHODS: Medical records of 1713 consecutive subjects who received cosmetic wide conjunctivectomy plus postoperative topical mitomycin C by a single surgeon at a single center with or without bevacizumab injection from November 2007 to May 2010 were reviewed. A telephone interview was conducted with 557 of the subjects who could be contacted and agreed to participate in the study. Complications, recurrences, and patient satisfaction were the main outcome measures. RESULTS: A total of 1713 consecutive patients underwent cosmetic wide conjunctivectomy to treat conjunctival hyperemia. Ocular diagnoses in the medical records at the time of surgery included hyperemia (8.8%), pterygium (14.0%), dry eye (3.5%), pinguecula (1.5%), and conjunctival disorder (23.3%). For the remaining 48.9% of subjects, the diagnosis was not mentioned, or the surgical procedure was for cosmetic purposes. Patients were followed for a mean of 10.9 months (range, 0-30.3 months). The overall complication rate was 82.9%, of which 55.6% were considered severe (fibrovascular conjunctival tissue proliferation, 43.8%; scleral thinning, 4.4%; scleral thinning with calcified plaques, 6.2%; intraocular pressure elevation, 13.1%; diplopia, 3.6%; and recurrence of hyperemic conjunctiva, 28.1%). CONCLUSIONS: Cosmetic wide conjunctivectomy plus postoperative topical mitomycin C with or without bevacizumab injection has a high rate of complications and reoperations.