Ultrasound Killed the Pelvic Examination: Over-reliance on Ultrasound Resulted in Delayed Diagnosis of Fitz-Hugh-Curtis Syndrome and Potential Loss of Fertility in a Young Female Patient.

We describe a case of multiple missed opportunities to diagnose Fitz-Hugh-Curtis syndrome in a sexually active 26-year-old woman in the emergency department (ED). Repeat ultrasound scans showed a hemorrhagic ovarian cyst. Multiple ED providers relied exclusively on these ultrasound findings as the presumed cause of her pelvic pain, to the detriment of their physical examination. A manual pelvic examination was not performed until her fourth ED return visit, which showed mucopurulent discharge. On the basis of our findings, obstetrics and gynecology team was consulted and the patient underwent diagnostic laparoscopy, which revealed extensive adhesions suggestive of pelvic inflammatory disease (PID) and Fitz-Hugh-Curtis syndrome. With the advent of ultrasound, we have noticed providers rely on technology to the detriment of their physical examination skills. Many ED providers are hesitant to perform a pelvic examination when a transvaginal ultrasound has already suggested a cause of the patient's pain. Ultrasound will not and cannot diagnose PID.

Evolution of the Prevalence of Myopia among Taiwanese Schoolchildren: A Review of Survey Data from 1983 through 2017.

PURPOSE: The aim of this study was to evaluate the changes in the prevalence of myopia in Taiwanese schoolchildren over the past few decades and to analyze the risk factors for myopia. DESIGN: Analysis of 8 consecutive population-based myopia surveys conducted from 1983 through 2017. PARTICIPANTS: An average of 8917 (5019-11 656) schoolchildren 3 to 18 years of age were selected using stratified systematic cluster sampling or by probability proportional to size sampling. METHODS: All participants underwent complete ophthalmic evaluations. Three drops of 0.5% tropicamide were used to obtain the cycloplegic refractive status of each participant. Questionnaires were used to acquire participant data from the 1995, 2005, 2010, and 2016 surveys. MAIN OUTCOME MEASURES: Prevalence of myopia (spherical equivalence of ≤-0.25 diopter [D]) and high myopia (≤-6.0 D) was assessed. Multivariate analyses of risk factors were conducted. RESULTS: The prevalence of myopia among all age groups increased steadily. From 1983 through 2017, the weighted prevalence increased from 5.37% (95% confidence interval [CI], 3.50%-7.23%) to 25.41% (95% CI, 21.27%-29.55%) for 7-year-olds (P = 0.001 for trend) and from 30.66% (95% CI, 26.89%-34.43%) to 76.67% (95% CI, 72.94%-80.40%) for 12-year-olds (P = 0.001 for trend). The prevalence of high myopia also increased from 1.39% (95% CI, 0.43%-2.35%) to 4.26% (95% CI, 3.35%-5.17%) for 12-year-olds (P = 0.008 for trend) and from 4.37% (95% CI, 2.91%-5.82%) to 15.36% (95% CI, 13.78%-16.94%) for 15-year-olds (P = 0.039 for trend). In both the 2005 and 2016 survey samples, children who spent less than 180 minutes daily on near-work activities showed significantly lower risks for myopia developing (<60 minutes: odds ratio [OR], 0.48 and 0.56; 60-180 minutes: OR, 0.69 and 0.67). In the 2016 survey, spending more than 60 minutes daily on electronic devices was associated significantly with both myopia and high myopia (OR, 2.43 and 2.31). CONCLUSIONS: The prevalence of myopia among schoolchildren increased rapidly from 1983 through 2017 in Taiwan. The major risk factors are older age and time spent on near-work activities. Use of electronic devices increased the amount of time spent on near-work and may increase the risk of developing myopia.

Pharmacotherapeutic candidates for myopia: A review.

This review provides insights into the mechanism underlying the pathogenesis of myopia and potential targets for clinical intervention. Although the etiology of myopia involves both environmental and genetic factors, recent evidence has suggested that the prevalence and severity of myopia appears to be affected more by environmental factors. Current pharmacotherapeutics are aimed at inhibiting environmentally induced changes in visual input and subsequent changes in signaling pathways during myopia pathogenesis and progression. Recent studies on animal models of myopia have revealed specific molecules potentially involved in the regulation of eye development. Among them, the dopamine receptor plays a critical role in controlling myopia. Subsequent studies have reported pharmacotherapeutic treatments to control myopia progression. In particular, atropine treatment yielded favorable outcomes and has been extensively used; however, current studies are aimed at optimizing its efficacy and confirming its safety. Furthermore, future studies are required to assess the efficacy of combinatorial use of low-dose atropine and contact lenses or orthokeratology.

Myopia among schoolchildren in East Asia and Singapore.

Myopia is highly prevalent among schoolchildren in East Asia and Singapore; however, its prevalence has been gradually increasing, and the number of population-based and non-population-based studies assessing this trend has increased in the past 10 years. Although the causes of this high prevalence in East Asia and Singapore remain poorly identified, related studies have discussed the associated risk factors. We summarize the data concerning the prevalence rates reported in related studies and discuss the most crucial risk factors among these schoolchildren.

Polymorphisms in steroidogenesis genes, sex steroid levels, and high myopia in the Taiwanese population.

PURPOSE: To evaluate the relationship among single nucleotide polymorphisms (SNPs) in steroidogenesis enzyme genes, serum levels of sex steroids, and high myopia in Taiwanese male and female populations. METHODS: A campus-based sample of 283 cases (145 males and 138 females) with high myopia and 280 controls (144 males and 136 females) with low myopia or emmetropia was studied. Estradiol, progesterone, and testosterone levels were determined using enzyme-linked immunosorbent assay kits. We genotyped six SNPs within five steroidogenesis enzyme genes (17 alpha-hydroxylase/17,20 lyase [CYP17A1], 3 beta-hydroxysteroid dehydrogenase [HSD3B1], 17 beta-hydroxysteroid dehydrogenase 1 [HSD17B1], steroid-5-alpha-reductase, alpha polypeptide 2 [SRD5A2], and aromatase [CYP19A1]) using polymerase chain reaction-restriction fragment length polymorphism methods. Student's t-tests, χ(2) tests, logistic regression, multifactor dimensionality reduction (MDR) methods, and ANOVA were used to determine significance. RESULTS: An MDR analysis corroborated the synergistic genotype association and demonstrated that synergistic interaction between rs6203 (HSD3B1), rs10046 (CYP19A1), and sex might confer susceptibility to high myopia (p=0.019). In both male and female subjects, levels of testosterone were significantly higher in cases than in controls; in male subjects, the levels of estradiol were significantly higher and those of progesterone were significantly lower in cases (all p-values <0.001). The rs605059 (HSD17B1), with sex-gene interaction, showed association with estradiol levels in males (p=0.035) and testosterone levels in females (p=0.027). CONCLUSIONS: Testosterone levels correlate with high myopia, and interaction of steroidogenesis enzyme genes and sex may be a modulating factor in sex hormone metabolism and high-myopia risk.

Examining rhodopsin retention in endoplasmic reticulum and intracellular localization in vitro and in vivo by using truncated rhodopsin fragments.

More than 100 mutations of rhodopsin have been identified to be associated with retinitis pigmentosa (RP), and mostly autosomal-dominant RP (ADRP). The majority of rhodopsin-associated ADRP is caused by protein misfolding and ER retention. In this study, we aimed to evaluate rhodopsin folding, exiting the ER and intracellular localization through expression of the rhodopsin fragments in COS-1 cells as well as in the transgenic zebrafish. We cloned human rhodopsin cDNA, which was then divided into the N-terminal domain, the C-terminal domain, and the fragment between the N- and C-terminal domains, and examine their intracellular expression in vitro and in vivo. We introduced a point mutation, either F45L or G51V, into this fragment and observed the intracellular localization of these mutants in COS-1 cells and in the zebrafish. The results revealed all of the truncated rhodopsin fragments except for the C-terminal domain and the full-length rhodopsin which had some plasma membrane localization, formed aggregates nearby or within the ER in COS-1 cells; however, the N-terminally truncated rhodopsin fragment, the C-terminal domain, and the full-length rhodopsin could traffic to the ROS in the zebrafish. Besides, the F45L mutation and the G51Vmutation in the rhodopsin fragment between the N- and C-terminal domains produced different effects on the aggresome formation and the intracellular distribution of the mutants both in vivo and in vitro. This current study provides new information about the mutant rhodopsin as well as in treatment of the RP in humans in the future.

Comparing myopic progression of urban and rural Taiwanese schoolchildren.

PURPOSE: To compare myopic progression rates in Taiwanese schoolchildren between urban and rural areas. METHODS: Several longitudinal studies of myopic progression were performed in urban and rural areas. Five primary schools, four junior high schools, and two senior high schools were selected from both urban and rural areas. Ages ranged from 7 to 18 years. The refractive state of each student was measured with an autorefractometer under cycloplegia. RESULTS: Mean myopic progression in primary school children (ages 7 to 12) in the urban areas was around 0.20 D/year for boys and 0.27 D/year for girls. The mean myopic progression rate in urban children from primary to junior high school age (ages 10 to 15) was 0.43 D/year for boys and 0.50 D/year for girls, faster than that in rural children (0.24 and 0.31 D/year, respectively). The average progression rate was fastest in children in junior high school (ages 13 to 15), around 0.45 D/year in urban areas and 0.28 D/year in rural areas. In senior high schools (ages 16 to 18), myopic progression slowed to 0.17 D/ year in boys and 0.33 D/year in girls. Myopic progression in all groups was faster in myopic eyes than in emmetropic or hyperopic eyes. CONCLUSIONS: The average myopic progression in urban areas was greater than that in rural areas. Environmental factors such as urban development and academic grade level may be important contributing factors to myopic progression.

Long-term evaluation of refractive status and optical components in eyes of children born prematurely.

PURPOSE: To evaluate the refractive status and optical components in school age children born prematurely and to examine the risk factors associated with refractive errors. METHODS: The participants were a cohort of children aged 7 to 9 years with gestational age less than 35 weeks or birth weight less than 1500 g. The participants' neonatal histories were reviewed; their refractive status and optical components were measured. The study results were compared with the results of age-matched children from a national survey. RESULTS: Of the 108 children studied, 48 (44%) had retinopathy of prematurity (ROP); 29 (27%) had ROP ≥ stage 3. Compared with the control subjects, the study cases showed higher prevalence of myopia (48% vs. 29%), hyperopia (23% vs. 15%), and astigmatism (73% vs. 41%). Common ocular features included shallow anterior chamber depth (ACD), thick lenses, and steep corneal curvature. The hyperopic cases had the shortest axial length (AL), whereas the myopia cases had significantly shallower ACD and greater LT. Those with a history of ROP had more prominent changes in the anterior segment. Generalized estimating equations showed that refractive errors could be predicted by a combination of optical components. CONCLUSIONS: In children born prematurely, the development of myopia is mainly influenced by anterior segment components, whereas hyperopia is mainly attributable to short AL. Astigmatism is primarily cornea-related. A combination of various optical components results in complicated refractive outcomes. The presence of ROP may be associated with significantly shorter ACD, thicker lens, and higher myopia and astigmatism. (ClinicalTrials.gov number, NCT01045616.).

Dose escalation study of the safety, tolerability, and pharmacokinetics of nemonoxacin (TG-873870), a novel potent broad-spectrum nonfluorinated quinolone, in healthy volunteers.

Nemonoxacin (TG-873870) is a novel nonfluorinated quinolone with potent broad-spectrum activity against Gram-positive and Gram-negative pathogens, including methicillin-resistant Staphylococcus aureus, penicillin- and quinolone-resistant Streptococcus pneumoniae, and vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus. The safety, tolerability, and pharmacokinetics of nemonoxacin were investigated in a double-blind, ascending-single-dose study involving 56 healthy subjects (48 males and 8 females) who were randomly assigned to 1 of 7 dose cohorts. In each successive cohort, two subjects received a placebo and six received single oral doses of 25, 50, 125, 250, 500, 1,000, or 1,500 mg nemonoxacin. Nemonoxacin was well tolerated up to the maximum dose of 1,500 mg. No severe or serious adverse events were observed. The most frequent adverse events were contact dermatitis, pruritus, and erythema. No clinically significant abnormalities were noted in the electrocardiograms, vital signs, or laboratory tests. The plasma concentrations increased over the dose range, and at 500 mg, the free area under the plasma concentration-time curve/MIC(90) ratios and free maximum nemonoxacin concentration/MIC(90) ratios against drug-sensitive/drug-resistant S. pneumoniae and S. aureus were greater than 227 and 24, respectively. The peak time and elimination half-life of nemonoxacin were 1 to 2 h and 9 to 16 h, respectively. The oral clearance was approximately 0.22 liter/h/kg. The plasma protein binding was approximately 16%. The results of this study support further evaluation of the multiple-dose safety, tolerability, and pharmacokinetics of nemonoxacin.

Estimation of heritability in myopic twin studies.

PURPOSE: To examine the genetic and environmental factors for myopia at the family level, as well as risk factors such as ocular measurements and environmental covariates at the individual level, by analysis of myopic twin data. METHODS: A myopic twin study was conducted on participants from the 2000 Guinness World Records for twins in Taiwan. A total of 130 participants comprising 58 twin pairs and 13 siblings were recruited. The generalized estimating equation approach was used to evaluate the covariate effects. A Bayesian linear mixed model was then used to estimate the heritability. RESULTS: Pearson's intrapairwise correlation coefficients for ocular refraction and its components were higher among monozygotic twins than among dizygotic twins. The significance of sex suggested that women are more myopic than men. Both axial length and anterior chamber depth were significant factors associated with myopia. The results also showed that people with higher education levels were more likely to have a higher degree of myopia. After accounting for genetic and environmental effects and other covariates, the estimate of heritability of myopia was as high as 0.306. CONCLUSIONS: After adjusting for environmental covariates, heritability still plays a decisive genetic role in the development of myopia.

The association of haplotype at the lumican gene with high myopia susceptibility in Taiwanese patients.

OBJECTIVE: To investigate the association of genetic polymorphisms in the dermatan sulfate proteoglycan 3 (DSPG3), lumican (LUM), and decorin (DCN) genes (component genes of the sclera) with high myopia susceptibility in Taiwanese people. DESIGN: Prospective case-control study. PARTICIPANTS: Hospital clinic-based samples of 120 unrelated patients with extremely high myopia were studied. One hundred thirty-seven unrelated emmetropic individuals served as controls. METHODS: Four, 8, and 4 single nucleotide polymorphism (SNPs) were genotyped within the DSPG3, lumican, and decorin genes, respectively, using direct DNA sequencing. Pairwise linkage disequilibrium, haplotype analysis, adjusted logistic regression, and multifactor dimensionality reduction (MDR) methods were used to determine significant associations. MAIN OUTCOME MEASURES: The association of haplotypes at the lumican gene with high myopia development. RESULTS: The lumican gene SNP rs3759223:T-->C demonstrated a significant association with high myopia (P = 2.83 x 10(-4)). Four lumican SNPs showed significant linkage disequilibrium and formed a haplotype block. Sliding window haplotype analyses revealed that the block consisting of rs3759223 and rs3741834 showed significant goodness of fit (global P = 1.0725 x 10(-6)). Haplotype-specific tests showed that the C-C and T-C haplotypes were associated significantly with high myopia, with odds ratios (95% confidence intervals) of 19.32 (2.55-146.54) and 0.69 (0.46-1.04), respectively. rs3759223 and rs3741834 are in a putative regulatory element of the lumican gene, which influences fibrillogenesis of scleral collagen fibers and the development of myopia. The results of an MDR analysis corroborated the single-locus association and suggested a significant 2-locus interaction model composed of SNPs rs2300588 and rs3741834 in the lumican gene. CONCLUSIONS: Genetic variation in the regulatory domains of the lumican gene, where both rs3759223 and rs3741834 are located, are associated with high myopia susceptibility among the Han Chinese, making this region worthy of further investigation.

Balloon dacryocystoplasty and monocanalicular intubation with Monoka tubes in the treatment of congenital nasolacrimal duct obstruction.

PURPOSE: To report our experience with combined use of balloon dacryocystoplasty and monocanalicular intubation with Monoka tubes for treating congenital nasolacrimal duct obstruction. DESIGN: Retrospective consecutive interventional case series. MATERIALS AND METHODS: This retrospective study consisted of 25 consecutive pediatric patients with congenital nasolacrimal duct obstruction who underwent balloon dacryocystoplasty and monocanalicular intubation with Monoka tubes between November 2003 and November 2006. Outcome evaluations included an ophthalmologic examination and a dye appearance test postoperatively. Age, history of a prior probing and complications related to the main outcome were also analyzed. RESULTS: Thirty-three eyes of 25 patients aged 8 months to 9 years (3.5 +/- 2.4 years old) were included. Of the obstructed ducts treated, 97% (32/33) showed complete resolution of epiphoria. When analyzed by age groups, patients more than 1 year of age had higher success rate (30 successes in 30 patients) than patients less than 1 year of age (two successes in three patients). Statistical analysis revealed no statistically significant difference in success rate between both age groups (p = 0.09). The mean duration of intubation was 5.7 +/- 2.2 months. No significant complication was noted, except that early tube dislodgements occurred in six out of 31 Monoka intubations (19%). CONCLUSIONS: The combined use of balloon dacryocystoplasty and monocanalicular intubation with Monoka tubes is an effective procedure for children with congenital nasolacrimal duct obstruction after failure of conservative treatment or probing.

Lens thickness changes among schoolchildren in Taiwan.

PURPOSE: To explore the possible influence of ocular growth, refractive error and age on the crystalline lens in school-age children. METHODS: A Taiwan nationwide survey of myopia performed in 2006 was used to determine the prevalence and severity of myopia and the changes in ocular components. A total of 11,656 students were enrolled, including 5,390 boys and 6,266 girls, with ages ranging from 7 to 18 years. Refractive status was measured with an autorefractometer with the subject under cycloplegia. Lens thickness, anterior chamber depth, and axial length were measured with biometric ultrasound. RESULTS: Data revealed that the crystalline lens became thinner between the ages of 7 and 11. Subsequent increases in the lens thickness correlated with age and the stability of myopia. This phenomenon was found not only in myopic eyes, but also in emmetropic and hyperopic eyes. The changes in anterior chamber depth inversely correlated with the changes in the lens. In school-age children, the ratio of lens/axial length was found to be significant: approximately 0.147 in the emmetropic group. However the ratio was seen to increase with age. The ratio of anterior segment/axial length was found to be approximately 0.3 in emmetropic eyes among all age groups and less than 0.3 in the myopic eyes of schoolchildren. CONCLUSIONS: Lens thinning appeared to be compensatory in nature with respect to the increased axial length of normal eye growth. Myopic eye growth induces the lens to compensate by becoming much thinner. The change in anterior chamber depth corresponded inversely with lens thickness.

The association of membrane frizzled-related protein (MFRP) gene with acute angle-closure glaucoma--a pilot study.

PURPOSE: The membrane frizzled-related protein (MFRP) has been proposed as a probable candidate gene for extreme hyperopia and nanophthalmos, which are factors for angle-closure glaucoma. The purpose of our study was to investigate whether there are significant associations between angle-closure glaucoma and sequence variants in the MFRP gene reported previously in Taiwanese subjects. METHODS: Genomic DNA was collected from 63 subjects with angle-closure glaucoma and 66 age-matched and gender-matched controls without angle-closure glaucoma. Three sequence variants were detected by polymerase chain reaction (PCR) and direct sequencing in all of the cases and controls. RESULTS: None of the three sequence variants showed a significant result in terms of association with disease. The pairwise linkage disequilibrium (LD) mapping confirmed that these alleles have a comparatively strong LD index greater than 0.7 for D' and greater than 0.4 for r(2) at these polymorphisms. However, we found there were no statistical associations between any of the three sequence variants located on MFRP and angle-closure glaucoma. CONCLUSIONS: In our pilot study, variations that we tested in MFRP were not associated with the development of acute angle-closure glaucoma in Taiwanese subjects.

Improvements in vision-related quality of life with AcrySof IQ SN60WF aspherical intraocular lenses.

PURPOSE: To compare vision-related quality of life and higher-order aberrations (HOAs) with an aspherical intraocular lens (IOL) (AcrySof IQ SN60WF) and a conventional spherical IOL (AcrySof SA60AT) (both Alcon) after phacoemulsification. SETTING: Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China. METHODS: Sixty-five patients were prospectively randomized to receive an Alcon AcrySof IQ SN60WF IOL (30 eyes) or an AcrySof SA60AT IOL (35 eyes). All patients had a complete ophthalmologic examination including uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), and wavefront analysis preoperatively and 3 months postoperatively. Patients also completed the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) to evaluate vision-related quality of life. RESULTS: The mean postoperative BSCVA (logMAR) was 0.09 +/- 0.07 (SD) in the aspherical IOL group and 0.12 +/- 0.08 in the spherical IOL group; the difference was not statistically significant. Spherical aberrations were statistically significantly lower in the aspherical IOL group (mean 0.12 +/- 0.23 microm) than in the spherical IOL group (mean 0.33 +/- 0.20 microm) (P = .001). Both IOL types improved most aspects of patients' vision-related quality of life. The aspherical IOL group had clinically significant improvement on more NEI VFQ-25 subscales, although the difference between groups in vision-related quality of life was not statistically significant. CONCLUSION: Eyes with the aspherical AcrySof IQ SN60WF IOL had reduced HOAs and spherical aberrations compared with eyes with the spherical AcrySof SA60AT IOL; however, there were no statistically significant differences in visual acuity or vision-related quality of life between groups.

Association between high myopia and progression of visual field loss in primary open-angle glaucoma.

BACKGROUND/PURPOSE: Taiwan has a very high prevalence rate of myopia. We retrospectively studied the influence of myopia on the progression of visual field (VF) loss in primary open-angle glaucoma (POAG) patients. METHODS: We studied 515 POAG patients for a minimum follow-up period of 5 years. VF examination was performed with Humphrey perimeter, 30-2 SITA standard program, every 6 months. A point-wise numerical comparison was applied to judge the VF changes. Test points showing more than 1.0 dB of sensitivity loss in mean defect were identified. A location was considered to have progression if it was detected on two consecutive visits. Progression of VF loss was confirmed if three or more test points deteriorated. Multivariate logistic regression was used to evaluate the association between progression of VF loss and various risk factors. RESULTS: There were 262 cases. Progression of VF loss occurred in 57 eyes (21.8%) during the 5-year follow-up period. Logistic regression revealed that the deterioration was associated with older age, higher mean intraocular pressure, larger vertical cup-to-disc ratio, and greater myopic refraction status. The incidence of VF loss progression was 15.1% in the group of eyes with myopia less than -3 D, 10.5% in the group with -3 D to -6 D, 34.4% in the group with -6 D to -9 D, and 38.9% in the group with myopia greater than -9 D. CONCLUSION: POAG patients with myopia greater than -6 D had a greater progression of VF loss.

Porous orbital implants, wraps, and PEG placement in the pediatric population after enucleation.

PURPOSE: To investigate complications of various porous orbital implants and wrapping materials in the pediatric population after enucleation. DESIGN: A retrospective, comparative, nonrandomized study. METHODS: Between November 1992 and November 2006, patients younger than 15 years old were collected for study participation. They underwent enucleation with porous orbital implants primarily or secondarily at National Taiwan University Hospital. The authors used the hydroxyapatite (HA), Medpor, and Bioceramic orbital implant. The HA implant was wrapped with four different materials: donor sclera, Lyodura, porcine sclera, and Vicryl mesh. A part of HA implants and all bioceramic implants were wrapped with Vicryl mesh, added anteriorly with scleral patch grafts. All Medpor implants were unwrapped. RESULTS: Forty-seven cases had more than a two-year follow-up. The exposure rates according to implants and wraps were: donor sclera-wrapped HA (two of nine, 22%), porcine sclera-wrapped HA (three of three, 100%), Vicryl mesh-wrapped HA (one of five, 20%), and unwrapped Medpor (one of four, 25%). No exposure was found in four Lyodura-wrapped HA implants, and 22 Vicryl mesh-wrapped HA and Bioceramic implants with anteriorly scleral coating. The exposure rate was lower in cases with implants wrapped by our method and Lyodura than in those with implants wrapped by other materials (P < .001). Of 47 patients, 20 (42.5%) were fitted with peg-coupled prostheses and all had good prosthetic movements subjectively. CONCLUSIONS: Different types of implants and wraps resulted in various exposure rates in the pediatric population. The modified wrapping technique may prevent porous implants from exposure in children.

The genetic effect on refractive error and anterior corneal aberration: twin eye study.

PURPOSE: To investigate the role of heredity in determining refractive variables, anterior corneal curvature, and anterior corneal aberrations. METHODS: Thirty-three monozygotic and 10 dizygotic twin pairs were enrolled in this study. Corneal curvature, corneal astigmatism, and corneal topography were obtained from computerized videokeratoscope. The CTView program was used to compute anterior corneal aberrations from corneal height data of the videokeratoscope. Correlation analysis was performed to investigate the symmetry of the refractive error, corneal curvature, corneal astigmatism, and anterior corneal aberrations between right and left eyes of each twin pair. Heritability (h2) of these parameters was also calculated. RESULTS: Positive correlations were noted between right and left eyes for spherical power, total astigmatism, mean corneal curvature, and corneal astigmatism. In monozygotic twins, vertical coma, secondary vertical coma, spherical aberration, and secondary spherical aberration were moderately correlated. In dizygotic twins, vertical coma, secondary horizontal coma, and spherical aberration were moderately correlated. In unrelated controls, secondary vertical coma, secondary horizontal coma, and secondary spherical aberration were moderately correlated. Root-mean-square (RMS) of higher order aberrations (3rd to 6th orders), RMS of spherical aberration, and RMS of coma were moderately correlated between right and left eyes in all three groups. Heritability of spherical aberration, RMS of spherical aberration, and corneal astigmatism (h2 = 0.56, 0.44, and 0.46) were greater than those of refractive power, corneal curvature, and other higher order aberrations. CONCLUSIONS: These results suggest that corneal astigmatism and spherical aberration possess a greater genetic predisposition than those of other refractive errors and higher order aberrations.

Porous polyethylene implants in orbital floor reconstruction.

BACKGROUND/PURPOSE: Various alloplastic materials are used in orbital wall reconstruction. This study investigated the outcome of patients treated with porous polyethylene sheet implants in the reconstruction of orbital floor fracture. METHODS: Twenty-one patients who underwent orbital reconstructions using 0.85-mm porous polyethylene sheets for the repair of orbital floor fracture were included. A transconjunctival approach was used in all patients. The mean duration of postoperative follow-up was 29.7 +/- 12.3 months. Postoperatively, results and complications such as infection and implant extrusion were followed-up on the first day, the first week, monthly for the first 3 months and then every 3-6 months thereafter. RESULTS: All 21 patients had symptomatic diplopia before surgery. The diplopia resolved in 14 patients and improved in seven patients within the first month after surgery. All patients except one were free from diplopia at follow-up periods exceeding 6 months. Preoperative enophthalmos resolved in four of seven patients and improved in three. None of the patients developed orbital infection, implant exposure or migration, worsening diplopia, infraorbital anesthesia or loss of vision during follow-up. CONCLUSION: The study demonstrated that porous polyethylene implants in the repair of orbital wall fractures had good results with few complications.

Prevention of exposure of porous orbital implants following enucleation.

PURPOSE: To investigate effectiveness of adding a scleral patch graft on a Vicryl mesh-wrapped porous orbital implant to prevent exposure following enucleation. DESIGN: A retrospective, comparative, nonrandomized study. METHODS: From October 1996 to February 2006, 74 consecutive patients (74 sockets) who received porous orbital implants primarily or secondarily after enucleation at National Taiwan University Hospital (72 cases) and at Far Eastern Memorial Hospital (2 cases) were collected. Patient demographics, ocular diagnosis, the surgical technique, prior ophthalmic surgery, type, covering, and size of the implant, follow-up periods, and complications associated with pegs and implants were recorded. Group 1 patients received a Vicryl mesh-wrapped implant without a scleral patch graft. Group 2 patients received anterior capping with a scleral patch on the Vicryl mesh-wrapped implant. RESULTS: Of 74 identified cases, 12 were excluded for insufficient follow-up. The 62 remaining cases had more than a two-year follow-up. There were two implant exposures (12%, two of 17) in group 1. Retroauricular myoperiosteal graft and scleral patch were used to repair exposed implants successfully. No exposure was noted in group 2 (n = 45). A significant between-group difference in exposure rate was found (P = .02). Early conjunctival dehiscence followed by spontaneous healing occurred in three group 2 patients. CONCLUSIONS: Scleral patch graft and Vicryl mesh can act as duplicate barriers between anterior surface of implants and overlying soft tissue. The modified wrapping technique prevents porous implants from exposure effectively.