Herpesviral Keratitis Following COVID-19 Vaccination: Analysis of NHIS Database in Korea.

PURPOSE: The purpose of this study was to determine the risk of herpesviral keratitis associated with 4 coronavirus disease 2019 (COVID-19) vaccines approved in South Korea, using large-scale data from the National Health Insurance Service. METHODS: The study included 8,528,254 individuals, with cohorts categorized based on COVID-19 vaccination status. Two investigations were conducted: The first aimed to assess the risk of new-onset herpesviral keratitis while the second study focused on the risk of relapse in individuals with a preexisting diagnosis. Propensity score matching was used for cohort balancing, and various covariates, including vaccine types and comorbidities, were considered. Statistical analyses, including Cox proportional hazard regression, were used to calculate adjusted hazard ratio (aHR) and assess the risk of herpesviral keratitis. RESULTS: Individuals receiving COVID-19 vaccination exhibited a higher risk of new-onset herpesviral keratitis compared with the unvaccinated control group (aHR 1.43, 95% confidence interval, 1.19-1.73). Both mRNA and non-mRNA vaccines demonstrated an increased risk. Individuals with preexisting herpetic keratitis who received COVID-19 vaccination showed a higher risk of relapse herpesviral keratitis compared with the unvaccinated control group (aHR 1.98, 95% CI, 1.29-3.03). Sensitivity analyses supported the robustness of the results. CONCLUSIONS: This analysis of a large national health insurance database suggests an increased risk of both new-onset and relapse of herpesviral keratitis associated with COVID-19 vaccination in South Korea. While COVID-19 vaccination is crucial for pandemic control, health care providers should be aware of potential herpesvirus reactivation and consider appropriate prophylaxis and treatment for at-risk individuals.

The effects of self-video feedback on the eyedrop instillation techniques of glaucoma patients: a prospective randomized controlled trial.

BACKGROUND: To evaluate the effectiveness of instillation technique education using self-video feedback in glaucoma patients. METHODS: Sixty-two patients who self-instilled glaucoma eyedrops were randomly assigned to the self-video feedback and control groups according to the block randomization. Each group of the patient was asked to instill eyedrops, and videos were recorded. For the control group, only an educational video was provided. In the self-video feedback group, the patients provided educational video and feedback using a recorded video of their own instillation. After 1 month of education, the patient's instillation techniques were video-recorded again. We divided the steps of instilling eyedrops into ten steps and evaluated whether each step was properly performed using the recorded images from each patient. The main outcome was the proportion of patients who properly instilled their eyedrops in each step. RESULTS: Before education, there was no significant difference in the proportion of patients who were properly instilled between the two groups. In the group that received video feedback, the proportion of patients who instilled the eyedrops correctly after education in some items was significantly higher than that of the control group, and in particular, the educational effect of 'avoids touching dropper to eyelid or eyelash' was superior. CONCLUSIONS: In patients with glaucoma, education on the method of instillation was effective in improving the techniques of instillation. In the items that required accurate actions, the video feedback that allowed the patient to observe themselves had a better improvement effect compared to the traditional education method. TRIAL REGISTRATION NUMBER: KCT0008090 (09/01/2023, retrospectively registered).

Bidirectional Association Between Sudden Sensorineural Hearing Loss and Glaucoma: A Cohort Study.

OBJECTIVES: To investigate the bidirectional association between sudden sensorineural hearing loss (SSNHL) and open-angle glaucoma (OAG) over a 12-year follow-up period using nationwide, population-based data. METHODS: The study was conducted using the National Health Information Database of the National Health Insurance Service (NHIS-NHID), which covered 3.5 million individuals from 2008 to 2019. In Study 1, we evaluated the effect of OAG on SSNHL, and in Study 2, we evaluated the effect of SSNHL on OAG. Participants of the control group were enrolled through "greedy nearest-neighbor" 1:1 propensity score matching. RESULTS: In Study 1, 26,777 people were included in each group. The hazard ratio (HR) for SSNHL of the OAG group was 1.27 (95% confidence interval [CI], 1.15-1.39). In subgroup analysis, there was significant HR value regarding (old age: 1.17, hyperlipidemia: 1.19). In Study 2, 15,433 people were included in each group. The HR for OAG of the SSNHL group was 1.18 (95% CI, 1.07-1.30). In subgroup analysis, the HRs were significant for old age (2.31), hypertension (1.17), diabetes (1.39), and hyperlipidemia (1.26). CONCLUSION: Over the 12-year follow-up, we found a bidirectional association between SSNHL and OAG, suggesting a shared pathogenesis. LEVEL OF EVIDENCE: N/A. Laryngoscope, 133:3169-3177, 2023.

Long-term effects of obstructive sleep apnea and its treatment on open-angle glaucoma: a big-data cohort study.

STUDY OBJECTIVES: The relationship between open-angle glaucoma (OAG) and obstructive sleep apnea (OSA) is unclear. The long-term risk for OAG after OSA diagnosis has not been investigated. Therefore, we assessed the risk for OAG among patients with OSA over a 12-year follow-up period using nationwide, population-based data. METHODS: The OSA group was randomly selected from among 3.5 million individuals registered with the National Health Insurance Service. The non-OSA group was obtained through propensity score matching considering several variables. The primary endpoint was glaucoma diagnosis. RESULTS: The OSA and non-OSA groups both included 6,369 individuals. The overall hazard ratio for OAG in the OSA group was 1.42 (95% confidence interval [CI]: 1.19-1.69). In subgroup analysis, the hazard ratio for OAG was 1.94 (95% CI: 1.57-2.41) for those aged > 60 years, 1.50 (95% CI: 1.20-1.89) for those with diabetes mellitus, 1.53 (95% CI: 1.26-1.86) for those with hypertension, and 0.71 (95% CI: 0.52-0.96) for those with a history of OSA surgery. CONCLUSIONS: Over the 12-year follow-up, the risk for OAG increased after OSA diagnosis. Further research will be necessary to determine if treating OSA can mitigate this association. CITATION: Lee T-E, Kim JS, Yeom SW, Lee MG, Lee JH, Lee H-J. Long-term effects of obstructive sleep apnea and its treatment on open-angle glaucoma: a big-data cohort study. J Clin Sleep Med. 2023;19(2):339-346.

Methodology and Rationale for Ophthalmic Examinations in the Seventh and Eighth Korea National Health and Nutrition Examination Surveys (2017-2021).

This report provides a detailed description of the methodology for ophthalmic examinations according to the Korea National Health and Nutrition Examination Survey (KNHANES) VII and VIII (from 2017 to 2021). The KNHANES is a nationwide survey which has been performed since 1998 in representatives of whole Korean population. During the KNHANES VII and VIII, in addition to the ophthalmic questionnaire, intraocular pressure measurement, visual field test, auto refractometry, axial length and optical coherence tomography measurements were included. This new survey will provide not only provide normative and pathologic ophthalmic data including intraocular pressure, refractive error, axial length, visual field and precise measurement of anterior segment, macula and optic nerve with optical coherence tomography, but also a more accurate diagnosis for major adult blindness diseases, including age-related macular degeneration, diabetic retinopathy, glaucoma, and other ocular diseases, for the national Korean population.

The effects of peripheral anterior synechiae on refractive outcomes after cataract surgery in eyes with primary angle-closure disease.

ABSTRACT: Objective of the study was to investigate the effects of peripheral anterior synechiae (PAS) on refractive outcomes after cataract surgery in eyes with primary angle-closure disease (PACD).This is a retrospective, cross-sectional study. Seventy eyes of 70 PACD patients who underwent phacoemulsification and intraocular lens implantation. Patients were divided into 2 groups based on the presence of PAS on preoperative gonioscopy. The predictive power of the intraocular lens was calculated by the SRK/T, Hoffer Q, Haigis, and Holladay formulae. The mean absolute error (MAE) and predicted refractive errors were compared between PAS (+) and PAS (-) groups. We also evaluated the refractive errors with regards to the extent of PAS in the subanalyses.The mean MAE was greater in the PAS (+) group with all formulae (0.61-0.70 diopters [D] vs 0.33-0.45 D, all P < .05). The eyes with PAS tended towards myopia (-0.30 D to -0.51 D vs -0.05 D to +0.24 D, all P < .05). However, the MAEs or predicted refractive errors were not different, irrespective of the extent of PAS in the subanalyses (all, P > .05).The presence or absence of PAS may influence the postoperative refractive outcomes in PACD patients.

Comparison of Three Different Tonometers in Eyes with Angle Closure.

SIGNIFICANCE: Precise measurement of intraocular pressure (IOP) is essential when diagnosing and managing glaucoma. We compared the IOP readings of three different tonometers and analyzed agreement among tonometers in eyes with high IOPs. PURPOSE: The purpose of this study was to compare the IOP readings obtained using a Goldmann applanation tonometer (GAT), a rebound tonometer (RT), and a Tono-Pen (TP) in angle-closure eyes with elevated IOP before and after medical IOP-lowering therapy. METHODS: Twenty-five eyes of 25 patients with angle closure and IOPs of greater than 30 mmHg were enrolled. Intraocular pressure was measured using RT (iCare Pro), TP (Tono-Pen XL), and GAT before and after medical treatment. The mean IOP readings of the tonometers were compared before and after treatment. The agreement among the tonometers was assessed via Bland-Altman analysis. RESULTS: The measurements from 22 eyes of 22 patients were suitable for statistical analyses. Before medical treatment, the mean TP-IOP was significantly lower than the mean GAT-IOP (44.0 ± 10.3 vs. 50.4 ± 8.9 mmHg, respectively; P < .001), but no significant difference was evident between the RT-IOP and the GAT-IOP (50.8 ± 10.9 vs. 50.4 ± 8.9 mmHg, respectively; P = .79). After IOP-lowering treatment, the mean GAT-IOP (14.9 ± 4.7 mmHg) did not differ from either the mean RT-IOP (15.6 ± 4.4 mmHg) or the mean TP-IOP (15.4 ± 5.0 mmHg; P = .05 and P = .18, respectively). The random measurement error among tonometers was greater for high IOP readings. CONCLUSIONS: Compared with RT or GAT, TP underestimated IOP in angle-closure eyes with a GAT-IOP of greater than 30 mmHg. Intraocular pressure reading agreement among the three tonometers was lower in eyes with high IOP.

Isotretinoin-induced Angle Closure and Myopic Shift.

PURPOSE: To report and describe the management a rare case of transient bilateral angle closure with increased intraocular pressure (IOP) and myopic shift while on isotretinoin therapy for acne. METHODS: A 28-year-old woman presented with bilateral myopic shift, angle closure with IOP increase, and supraciliary effusion 1 week after acne therapy with isotretinoin. Two weeks after stopping isotretinoin, and treatment with topical prednisolone acetate, atropine, and fixed combination of timolol and dorzolamide, refraction, IOP returned to normal and supraciliary effusions was decreased on ultrasound biomicroscopy. CONCLUSIONS: Oral isotretinoin for acne treatment may be associated with an adverse reaction, resulting in bilateral transient myopia and angle closure with IOP elevation.

Comparison of Retinal Vessel Diameter Between Open-Angle Glaucoma Patients With Initial Parafoveal Scotoma and Peripheral Nasal Step.

PURPOSE: To compare retinal vessel diameters (RVDs) between open-angle glaucoma (OAG) patients with initial parafoveal scotoma (PFS) and those with initial peripheral nasal step (PNS). DESIGN: Retrospective, cross-sectional study. METHODS: We enrolled 151 eyes of 151 patients with OAG (83 with normal-tension glaucoma [NTG] and 68 with primary open-angle glaucoma [POAG]). The patients were categorized into the PFS and PNS groups according to the location of the initial visual field (VF) defect. Clinical characteristics and RVD indices-central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE)-were compared between the groups. Subgroup analyses were conducted in the NTG and POAG groups. RESULTS: Forty-six patients had PFS and 105 had PNS. The CRAE of the PFS group was significantly lower than that of the PNS group in all glaucoma patients (P = .001). However, neither the mean deviation in VF nor that in the average retinal nerve fiber layer thickness showed significant intergroup differences. In the NTG subgroup analysis, the CRAE of the PFS group was significantly lower than that of the PNS group (P = .013). Conversely, in the POAG subgroup analysis, the CRAE in the PFS group did not differ significantly from that in the PNS group (P = .123). CONCLUSIONS: Retinal arteriolar diameter was narrower in OAG patients with initial PFS than in those with initial PNS, especially in the NTG group. This suggests that the initial location of the VF defect may be associated with the vascular mechanism in patients with glaucoma.

Retinal vessel diameter in bilateral glaucoma suspects: comparison between the eye converted to glaucoma and the contralateral non-converted eye.

PURPOSE: To investigate retinal vessel diameter in patients classified as bilateral glaucoma suspects who showed unilateral glaucomatous conversion. METHODS: This retrospective study included 21 patients who had initially been diagnosed as bilateral glaucoma suspects but showed unilateral glaucomatous conversion during a follow-up period of more than 2 years. Conversion to glaucoma was determined either by documentation of a new retinal nerve fiber layer defect on red-free photography or a reproducible glaucomatous visual field defect. The central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) were measured from fundus photographs taken at baseline and at the point of glaucoma conversion. RESULTS: The mean CRAE of the converted eyes was significantly lower than that of the non-converted eyes at baseline (164.9 ± 13.2 µm vs 175.2 ± 15.6 µm; p = 0.001), but no significant difference was observed in the mean CRVE (p = 0.108). The mean CRAE of the converted eyes was also lower than in the non-converted eyes at the point of glaucoma conversion (158.6 ± 13.5 µm vs 168.0 ± 17.2 µm; p = 0.011). CONCLUSION: In bilateral glaucoma suspects, there was a significant inter-eye difference in CRAE at baseline between eyes that converted to glaucoma and those that did not. These findings suggest that measurement of retinal arteriolar diameter may help clinicians when evaluating the risk of conversion in glaucoma suspects.

Twenty-four-hour efficacy of preservative-free tafluprost for open-angle glaucoma patients, assessed by home intraocular pressure (Icare-ONE) and blood-pressure monitoring.

PURPOSE: To evaluate the effect of preservative-free (PF) tafluprost on diurnal variation of intraocular pressure (IOP) and ocular perfusion pressure (OPP), measured by use of home IOP and blood-pressure (BP) monitoring devices, for primary open angle glaucoma (POAG) patients. METHODS: Twenty-two eyes from 22 patients with POAG were studied. Initially, IOP was measured at the hospital by Goldmann applanation tonometry (GAT) and Icare-ONE rebound tonometry. Each patient was then instructed how to use the Icare-ONE and BP home monitoring devices. IOP and BP were measured at home by the patients, every 4 h, before and 2 weeks after once daily treatment with PF tafluprost (0.0015%) ophthalmic solution. RESULTS: Intraclass correlations between different IOP measurements were greater than 0.8. PF tafluprost reduced mean diurnal IOP significantly for patients with POAG, from 15.7 ± 1.2 mmHg at baseline to 12.5 ± 0.6 mmHg 2 weeks after treatment (p < 0.001). It increased mean diurnal OPP from 48.5 ± 7.3 mmHg at baseline to 51.3 ± 7.0 mmHg post-treatment (p < 0.017). CONCLUSIONS: Icare-ONE enables glaucoma patients to measure their own diurnal IOP fluctuations. Patient-measured Icare-ONE IOP readings showed that PF tafluprost effectively reduced diurnal IOP in eyes with POAG.

Diagnostic Ability of Retinal Vessel Diameter Measurements in Open-Angle Glaucoma.

PURPOSE: To determine the diagnostic ability of retinal vessel diameter (RVD) measurements and the factors related to retinal vascular diameters in patients with open-angle glaucoma (OAG). METHODS: This retrospective observational study included 145 patients with OAG (63 with high-tension and 82 with low-tension glaucoma) and 60 healthy controls. The central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) were measured using the IVAN software version 1.3. Receiver operating characteristic (ROC) curves were obtained for the average retinal nerve fiber layer (RNFL) thickness and RVD indices including CRAE, CRVE, and CRAE/CRVE ratio. Areas under the ROC curves (AUCs), 95% confidence intervals (CIs), and sensitivities at a fixed specificity (>90% and >80%) were calculated. Factors related to CRAE were analyzed by simple and multiple linear regression analyses. RESULTS: Among the RVD indices, the CRAE had the largest AUC for discriminating glaucomatous changes between eyes with glaucoma and those without (0.803; 95% CI, 0.742-0.855). The AUC of CRAE did not significantly differ from that of average RNFL thickness (P = 0.134). However, CRAE showed lower sensitivity than average RNFL thickness at a specificity greater than 90%. Factors significantly associated with CRAE in both simple and multiple linear regression analyses were age, spherical equivalent, average RNFL thickness, presence of diabetes mellitus, and a glaucoma diagnosis (all P ≤ 0.05). CONCLUSIONS: The diagnostic ability of CRAE for detecting OAG was good, which was not much worse than that of average RNFL thickness. This finding suggests the potential usefulness of RVD for glaucoma detection.

Effect of Different Head Positions in Lateral Decubitus Posture on Intraocular Pressure in Treated Patients With Open-Angle Glaucoma.

PURPOSE: To investigate the effects of different head positions in the lateral decubitus posture on intraocular pressure (IOP) in medically treated patients with open-angle glaucoma (OAG). DESIGN: Prospective observational study. METHODS: setting: Institutional. PARTICIPANTS: Twenty patients with bilateral OAG who received only latanoprost as treatment. OBSERVATION PROCEDURES: IOP was measured using an ICare Pro tonometer in the sitting, supine, right, and left lateral decubitus posture. In lateral decubitus posture, IOP measurements were taken with 3 different head positions (30 degrees higher than, 30 degrees lower than, and parallel to the center of the thoracic vertebra) in a randomized sequence. MAIN OUTCOME MEASURES: Comparison of the IOPs between the dependent (lower-sided) and nondependent eyes in the lateral decubitus postures with different head positions. We also analyzed the differences in IOPs between the better and worse eyes. RESULTS: IOP was higher in the dependent eyes than in the nondependent eyes in lateral decubitus posture, regardless of the head position (all P < .05). Lower head position increased the IOP of dependent eyes, compared with the neutral or higher head position. However, the amounts of IOP elevation seen during the changes of body posture or head position were not significantly different between the better and worse eyes. CONCLUSIONS: Low head position elevates IOP of the dependent eyes of medically treated OAG patients compared with neutral head position in the lateral decubitus posture. Adjustment of the height of a pillow may help mitigate IOP elevations resulting from lying on the side with a low or no pillow in glaucoma patients.

Comparison of Intraocular Pressure Measurements between Icare Pro Rebound Tonometer and Tono-Pen XL Tonometer in Supine and Lateral Decubitus Body Positions.

PURPOSE: To compare intraocular pressure (IOP) measurements obtained using the Icare Pro rebound tonometer and Tono-Pen XL tonometer in supine and lateral decubitus body positions. METHODS: One-hundred eyes of 50 subjects (normal volunteers or glaucoma suspects) were enrolled in this prospective observational study. IOP was measured in both eyes using the Icare Pro and Tono-Pen XL in the sitting position and the recumbent positions including supine, right lateral decubitus and left lateral decubitus. IOP was measured five minutes after assuming each of the recumbent postures in a randomized sequence. The eye on the lower side in the lateral decubitus position was termed as the dependent eye. Agreement of IOP readings between the Icare Pro and Tono-Pen was assessed in all recumbent positions. Differences of IOP readings (ΔIOP) between the two tonometers and their correlations with ocular parameters were also assessed in all positions. RESULTS: The IOP readings obtained using Icare Pro and Tono-Pen showed good correlations in supine and lateral decubitus positions (all r > 0.7, p < 0.005), although Icare Pro readings were higher than Tono-Pen readings (all p < 0.001) in all positions. The ΔIOP showed a weakly positive correlation with central corneal thickness in both eyes, whereas such a positive correlation was found only in the dependent eye in the lateral decubitus positions (r = 0.307-0.531, all p < 0.005). Both the spherical equivalents and axial lengths were not correlated with ΔIOP in all positions. CONCLUSION: IOP readings obtained with Tono-Pen and Icare Pro tonometers showed good agreement in supine as well as in lateral decubitus positions, although Icare readings were higher than Tono-Pen readings in all positions. Such differences in IOP readings between the different tonometers need to be considered when measuring IOPs in various body positions.

Head position and intraocular pressure in the lateral decubitus position.

PURPOSE: To investigate the effects of different head positions in the lateral decubitus posture on intraocular pressure (IOP). METHODS: Seventeen healthy Korean subjects were included in this prospective observational study. Intraocular pressure measurements were taken with the subjects in the sitting position and the recumbent positions including supine, right lateral decubitus, and left lateral decubitus positions. In right and left lateral decubitus positions, IOP measurements were taken with three different head positions (30 degrees higher, 30 degrees lower, and parallel to the center of the thoracic vertebra) in a randomized sequence. Intraocular pressure was measured using the ICare Pro tonometer in both eyes 5 minutes after assuming each posture. The eye on the lower side in the lateral decubitus position was termed as the dependent eye. We assessed differences in the IOP of the dependent and nondependent eyes in the lateral decubitus positions with different head positions. RESULTS: Regardless of the head position, the dependent eyes showed higher IOP than the nondependent eyes in the lateral decubitus positions except in the left lateral decubitus with high head position (p < 0.001 for all positions except left lateral decubitus, p = 0.083). Low head position significantly increased the IOP of dependent eyes, compared with the neutral or high head positions in lateral decubitus posture. CONCLUSIONS: Low head position elevates the IOP of the dependent eyes compared with neutral head position in the lateral decubitus posture. Proper adjustment of the height of a pillow may help mitigate IOP elevations resulting from lying on the side with a low pillow or with no pillow.

Retinal vessel diameter in normal-tension glaucoma patients with asymmetric progression.

PURPOSE: To investigate the longitudinal changes in the central retinal vessel diameter in asymmetric progressive normal-tension glaucoma (NTG) patients. METHODS: This study included 27 patients with bilateral NTG without any systemic vascular disease who showed glaucomatous progression in one eye at the mean follow-up of 24.3 months (range, 18-29 months). Progression was determined by the development of new retinal nerve fiber layer (RNFL) defects or widening of pre-existing defects on red-free RNFL photographs. The central retinal arteriolar equivalent (CRAE) and the central retinal venular equivalent (CRVE) were measured at baseline and at the mean follow-up of 24.3 months. We classified the eyes of each patient as either progressed or stable eyes, and compared the differences and changes in the CRAE and CRVE. RESULTS: No significant inter-eye difference was observed at baseline in the mean CRAE (167.5 ± 22.2 µm vs. 168.2 ± 15.5 µm, p = 0.809) and in the mean CRVE (276.3 ± 18.2 µm vs. 281.6 ± 21.9 µm, p = 0.267) between the progressed and stable eyes. There were significant changes in CRAE in the progressed eyes between baseline and 2 years after baseline (from 167.5 ± 22.2 µm to 146.9 ± 18.0 µm, p < 0.0001), but there were no significant changes in the stable eyes (from 168.2 ± 15.5 µm to 167.5 ± 14.8 µm, p = 0.084). CONCLUSIONS: In our series of NTG patients with asymmetric progression, central retinal artery diameter decreased over time in the progressed eyes, whereas no significant decrease in the central retinal artery diameter was seen in the stable eyes.

Effects of different sleeping postures on intraocular pressure and ocular perfusion pressure in healthy young subjects.

OBJECTIVE: To investigate the effects of different sleeping positions of head and body on intraocular pressure (IOP) and ocular perfusion pressure (OPP) in healthy, young subjects. DESIGN: Prospective, comparative case series. PARTICIPANTS: Twenty healthy young Korean subjects. METHODS: We measured IOP and blood pressure (BP) with the subjects seated and recumbent, including supine, right lateral decubitus, left lateral decubitus, prone with right head turn, and prone with left head turn positions. We measured IOP using an Icare tonometer in both eyes 5 minutes after assuming each position in a randomized sequence. We calculated the OPP using the formulas based on the mean BP adjusted for the height of the eye over the heart. The eye on the lower side in the lateral decubitus or prone with head turn position was termed the dependent eye. MAIN OUTCOME MEASURES: Difference in IOP and OPP of the dependent and nondependent eyes during changes of sleeping positions of body and head. RESULTS: Mean IOP of right and left eyes while sitting was significantly lower than that measured in each recumbent position (all P<0.001). The OPPs in both eyes were significantly higher in all recumbent positions than in a sitting position (all P<0.001). Mean IOP of the dependent eyes was higher than that of the nondependent eyes in the lateral decubitus positions and in the prone positions with head turns (all P<0.001). No significant intereye difference in OPP was found for any position. Among IOPs measured in the recumbent positions, mean IOP of the dependent eye in the lateral decubitus position or in the prone position with head turn was significantly higher than that of the ipsilateral eye in the supine position (all P<0.0001). CONCLUSIONS: All sleeping positions of head and body resulted in an elevation of IOP and an increase in the calculated OPP compared with the sitting position in healthy, young subjects. The postural change from supine to lateral decubitus or prone with head turn position increased the IOP of the dependent eyes without significant alteration in OPP in healthy awake subjects. Further research is needed under nocturnal conditions in a sleep laboratory. FINANCIAL DISCLOSURES: The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Postoperative changes in spatial localization following exotropia surgery.

PURPOSE: To measure changes in spatial localization following exotropia surgery using a computer touch-screen method of measurement. METHODS: Enrolled in the study were 60 exotropia patients, all of whom had undergone corrective muscle surgeries under general anesthesia: 37 patients had undergone unilateral lateral rectus or bilateral lateral rectus muscle recession procedures (recession group) and 23 patients had undergone unilateral lateral and medial rectus muscle resection (R&R), or unilateral medial rectus resection only (resection group). We evaluated spatial localization by having patients point to targets on a computer touch-screen before surgery, and 1 day and 1 month after surgery. The pointing error, Δp, is defined as the difference between the actual location of the target and the pointed-to location of the target by unsigned value, was recorded as the mean of five tests. We compared the extent of postoperative changes in Δp between the two groups. RESULTS: The mean Δp before surgery did not differ statistically between the two groups (p = 0.93). One day after surgery, however, the postoperative change in Δp of the resection group compared with that of the recession group (2.0 ± 0.7° and 0.4 ± 0.5°, respectively) was significant (p = 0.01 and p = 0.86 respectively). CONCLUSIONS: The ability for spatial localization is decreased in patients immediately following medial rectus resection, but is regained by 1 month following surgery.

Clinical characteristics and treatment of blow-out fracture accompanied by canalicular laceration.

BACKGROUNDS: Blow-out fracture and canalicular laceration can occur simultaneously as a result of the same trauma. Despite its importance, little research has been conducted to identify clinical characteristics or surgical techniques for repair of a blow-out fracture accompanied by canalicular laceration. The aim of this study was to evaluate the clinical characteristics, the surgical approach, and the outcomes. METHODS: Thirty-four eyes of 34 patients who underwent simultaneous repair of canalicular laceration using silicone tube intubation and reconstruction of blow-out fracture were included. Medical records were retrospectively reviewed for patient demographics, nature of injury, affected canaliculus, location, and severity of blow-out fracture, associated facial bone fracture, ophthalmic diagnosis, length of follow-up period, and surgical outcome. RESULTS: Mean patient age was 40.0 years (range, 17-71 y). The mean follow-up was 7.3 months. Fist to the orbital area (10 patients, 29.4%) was the most common cause. There were 24 lower canalicular lacerations (70.6%), 6 upper canalicular lacerations (17.6%), and 4 upper and lower canalicular lacerations (11.8%). Isolated medial wall fractures were most common (area A4: 20/34, 58.8%). Fractures involving both the floor and medial wall and maxillo-ethmoidal strut (areas A1, A2, A3, and A4) were the second most common (6/34, 17.6%), and floor and medial wall with intact strut (areas A1, A2, and A4) were injured in 6 patients (17.6%). Pure inferior wall fractures were least frequent (areas A1 and A2: 2/34, 5.9%). The severity of the fracture was severe in most patients except for 1 linear fracture with tissue entrapment and 1 moderate medial wall fracture (32/34, 94.1%). There was lid laceration in 20 patients (58.8%). Nasal bone fracture (5/34, 14.7%) was the most common facial bone fracture. Tubes were removed at a mean of 3.3 months (range, 3-4 mo). In total, 31 patients (91.2%) achieved complete success in canalicular laceration and blow-out fracture repair. No significant complications were encountered. CONCLUSION: Fractures involving the medial wall with a lower canalicular laceration were the most common among concomitant blow-out fractures and canalicular lacerations. The severity of the fracture was most often classified as severe. Computed tomographic scan of the orbit and facial bones for identification of any additional injuries such as orbital wall and facial bone fractures should be performed in patients with canalicular laceration. To avoid disruption of the medial canthal area, repair of the canalicular laceration with silicone tube intubation was performed before reconstruction of the blow-out fracture through transconjunctival and transcaruncular approaches. Finally, the tube was fixed after blow-out fracture surgery, and these surgical orders yielded good surgical outcomes without complications.

Accommodative and tonic convergence and anatomical contracture in partially accommodative and non-accommodative esotropia.

PURPOSE: To compare accommodative convergence, tonic convergence, and anatomical contracture quantitatively in partially accommodative esotropia vs non-accommodative esotropia. METHODS: Patients with an esotropia who had undergone surgery under general anaesthesia were evaluated. They were divided into two groups: 17 patients had partially accommodative esotropia and 15 patients had non-accommodative esotropia (basic esotropia). We supposed that the total esodeviation (Eso) was composed of three components: accommodative convergence (AC), tonic convergence (TC), and anatomical contracture (AnC). We measured the preoperative angle of esodeviation with (AC) or without glasses (Eso) in awakening state at 1/3 m and the preoperative esodeviation under general anaesthesia (AnC). TC was calculated by the formula TC = EsoD-AC-AnC. RESULTS: The average ratios of TC/Eso, AC/Eso and AnC/Eso were 46%, 32%, and 22%, respectively in the partially accommodative esotrope group, and 28%, 1%, and 71%, respectively in the non-accommodative esotropes. These differences were significant for AC/Eso and AnC/Eso (p < 0.0001) but not for TC/Eso (p = 0.15). CONCLUSIONS: Among the three components, tonic convergence was responsible for a larger portion of esodeviation than anatomical contracture in partially accommodative esotropia, whereas anatomical contracture played a greater role in the non-accommodative esotropia group.