Anorexiant-induced transient myopia after myopic laser in situ keratomileusis

We report a case of acute transient myopia associated with ciliochoroidal effusion induced by anorexiants. The patient had had myopic laser in situ keratomileusis 7 years earlier. Acute bilateral myopia associated with anterior chamber shallowing, intraocular pressure elevation, diffuse ciliochoroidal effusion, and perimacular retinal folds was relieved 14 days after discontinuation of anorexiant medications. Tropicamide and atropine were used to deepen the anterior chamber. Sympathomimetic drugs such as phendimetrazine and ephedrine are used as anorexiants and may induce transient myopia associated with ciliochoroidal effusion, shallow anterior chamber, and acute angle-closure glaucoma.     

Mechanism of topiramate-induced acute-onset myopia and angle closure glaucoma

DESIGN: Interventional case report. METHODS: In an institutional practice setting, two women, aged 25 and 45, developed acute myopia after starting topiramate for epilepsy. One patient also developed bilateral angle closure glaucoma. RESULTS: Topiramate was discontinued. Anterior chamber shallowing was noted in both patients at presentation. Ultrasonography showed ciliochoroidal effusion. Baseline measurements of anterior chamber depth and lens thickness were obtained. CONCLUSIONS: Topiramate may be associated with ciliochoroidal effusion with forward displacement of the lens-iris diaphragm and anterior chamber shallowing, resulting in acute myopia and angle-closure glaucoma. Increased lens thickness contributes only minimally (9%-16%) to anterior chamber shallowing.     

Pathogenesis of transient high myopia after blunt eye trauma

OBJECTIVE: To determine the pathogenesis of transient high myopia after blunt eye trauma. DESIGN: Two observational case reports and literature review. METHODS: Refraction was measured in two patients with an autorefractometer in the acute and convalescent stages after a blunt eye injury. The anterior chamber angle, the ciliary body, and the choroid were examined by ultrasound biomicroscopy (UBM) in the acute and convalescent stages. In one patient, the anterior chamber depth, lens thickness, and axial length were measured by A-scan ultrasonography in the acute and convalescent stages. MAIN OUTCOME MEASURES: Comparison of the refraction, anterior chamber depth, lens thickness, axial length, and the UBM-determined appearance of the choroid and ciliary body during the acute stage with the values during the convalescent stages. RESULTS: The first patient showed a myopic shift of -9.75 diopters (D) and an anterior chamber shallowing of 0.94 mm measured 3 days after trauma by an air bag inflation compared with the measurements at the convalescent phase. UBM showed an annular ciliochoroidal effusion with ciliary body edema, anterior rotation of the ciliary processes, and disappearance of the ciliary sulcus. Eleven days after the injury, these UBM findings normalized, and the myopia decreased to -0.75 D, 27 days after trauma. The second patient had a myopic shift of -8.9 D compared with the convalescent phase, immediately after blunt trauma by a firework. Seven days after the injury, UBM revealed a partial cyclodialysis in addition to findings similar to those in the first patient. Ten days after injury, a myopic shift (-4.75 D), anterior chamber shallowing (by 1.1 mm), and thickening of the crystalline lens (by 0.27 mm) were observed compared with the convalescent phase. Associated UBM findings confirmed the anterior shift of the lens-iris diaphragm. Seventeen days after trauma, the UBM findings, including the cyclodialysis, were normalized, and the myopia had decreased to -1.0 D. CONCLUSIONS: Transient high myopia after blunt trauma is caused by anatomic changes in the ciliary body and crystalline lens. The anterior shift of the lens-iris diaphragm caused by ciliochoroidal effusion with ciliary body edema and thickening of the crystalline lens from blunt eye trauma are involved in traumatic high myopia.     

Malignant glaucoma induced by a phakic posterior chamber intraocular lens for myopia

A 23-year-old woman with -14.00 diopters of myopia requested emmetropia for professional reasons. An ICM 130 V2 myopic phakic intraocular lens (IOL) (Staar Surgical AG) was implanted in the posterior chamber. Three days later, the patient developed malignant glaucoma. Pupillary block glaucoma and choroidal hemorrhage or effusion were ruled out. As maximum medical treatment failed, rapid secondary surgery was performed with sclerotomy, aspiration in the midvitreous cavity, and removal of the IOL. The follow-up was 43 months.     

近视眼眼轴长度、前房深度及晶状体厚度的测量分析

目的探讨近视屈光度与眼袖长度、前房深度及晶状体厚度之间的关系。方法采用日本产NIDEK-US2520B型超声显像仪对屈光度在-3.00D以上的近视患者163例(312眼)进行眼轴长度、晶状体厚度和前房深度测量。结果随着近视度数的增加,其眼轴长度和前房深度明显增加,而晶状体厚度与眼轴长度的比值则显著降低(P<0.05)。在屈光度相同的各组中,眼轴长度、晶状体厚度和晶状体厚度与眼轴长度比值存在明显的性别差异(P<0.05),而前房深度的性别差异无显著性(P>0.05)。结论近视屈光度的增加可同时伴有眼轴长度、前房深度和晶状体厚度与眼轴长度比值的改变。     

高度近视糖尿病患者白内障术中前房维持方法的探讨

目的探讨高度近视糖尿病患者白内障术中维持正常前房深度的安全有效方法。方法回顾性地比较了高度近视糖尿病患者白内障术中维持前房深度的3种方法的有效性及其对术中操作的影响。其中将通过降低灌注瓶高度解决前房深度的患者分为A组，通过扩大侧切口解决前房深度的患者分为B组，将通过缓解反向瞳孔阻滞来解决前房深度的患者分为C组。结果C组方法较另外2种方法能更安全有效地维持术中正常的前房深度。结论合并糖尿病的高度近视患者白内障术中解除反向瞳孔阻滞对前房深度的维持非常重要。     

有晶状体眼前房虹膜夹持型人工晶状体植入治疗高度近视

目的：观察有晶状体眼前房型虹膜夹持人工晶状体植入治疗高度近视的临床疗效。 方法：对28例50眼高度近视患者进行有晶状体眼Verisyse前房虹膜夹持型人工晶状体植入手术,观察术后的裸眼视力、最佳矫正视力、眼压、角膜及前房内炎症变化情况。 结果：患者28例50眼均顺利在前房内植入虹膜夹持的人工晶状体,术后所有患者视力较术前均增加。术后1a,裸眼视力38眼（76%）≥1.0,12眼（24%）≥0.5,最佳矫正视力40眼（80%）≥1.0,10眼（20%）≥0.5。术后22眼最佳矫正视力均达到并超过术前最佳矫正视力。 结论：高度近视患者有晶状体眼前房植入虹膜夹持型人工晶状体是一种较好的安全有效的矫正视力的方法,术后屈光效果令人满意。     

高度近視眼合并白内障超聲乳化摘除術

目的觀察高度近視合并白内障超聲乳化摘除及人工晶狀體植入術的療效.方法對72例(79眼)高度近視白内障患者術前檢查眼軸長,計算人工晶狀體屈光度,經鞏膜隧道切口行超聲乳化摘除及人工晶狀體植入術,對術后視力及并發症進行觀察.結果 79眼術后視力不同程度提高,術后1月視力≥0.5者48眼,＜0.3者13眼,高度近視合并眼底病變是白内障術后視力不佳的原因.結論白内障超聲乳化摘除聯合人工晶狀體植入術是高度近視合并白内障較理想的手術方式,及早抓住手術時機,可以减少手術并發症的發生,獲得良好的手術效果.     

有晶状体眼前房人工晶状体植入矫正超高度近视

目的：观察有晶状体眼前房人工晶状体植入矫正超高度近视的临床效果。方法：11例18眼近视度数－11．00－30．00D（平均－21．25D）的超高度近视患者在表麻下前房内植入Phakic-6H-125型人工晶状体，随 访6－12个月（平均9．7月），结果：18眼术后裸眼视力均≥术前矫正视力，2者比较差别有显著性意义（P＜0．05），术后散光明显减轻，与术前相比较差别有显著性意义（P＜0．05），手术前后眼压比较差别无显著性意义（P＞0．05），3眼轻微瞳孔变形，1例2眼出现眩光感。结论：初步观察有晶状体眼前房人工晶状体植入矫正超高度近视具有安全，稳定及可预测性，是一种颇具前途的矫正超高度近视的手术，不适宜作准分子激光角膜原位磨镶术的超高度近视患者可谨慎选择该手术。     

有晶状体眼后房型人工晶状体植入术治疗高度近视的疗效

目的:分析有晶状体眼后房型人工晶状体植入术(ICL)对172治疗高度近视的临床疗效。方法:分析2007-09/2011-03行有晶状体眼后房型人工晶状体植入术患者35例70眼。术前常规检查视力、最佳矫正视力,进行各项重要检查后行有晶状体眼后房型人工晶状体植入术。结果:术后视力0.5～1.0。术后并发症出现白内障1例,一过性眼压升高1例,分别占患者总数的2.9%。白内障行超声乳化手术后视力恢复到1.0,青光眼经治疗后得到控制,视力达到0.8。结论:有晶状体眼后房型人工晶状体植入术治疗高度近视,特别是超高度近视(>-12.00D)效果确切。     

高度近视眼负低度数人工晶状体植入的临床观察

目的:观察超声乳化摘除联合负、低度数人工晶状体植入治疗高度近视性白内障的效果。方法:对66例94眼高度近视眼白内障行超声乳化摘除植入负、低度数人工晶状体,随访3mo。结果:术中2眼发生后囊破裂,术后3眼晶状体后囊混浊,无视网膜脱离者。结论:超声乳化摘除高度近视眼白内障是一种较好的手术方式,尤其同时植入负、低度数后房型人工晶状体增加了眼内组织的稳定性,防止了视网膜脱落,同时矫正了屈光不正。     

Aportes de la tomografía de coherencia óptica Visante® y la ecografía ocular en el diagnóstico y seguimiento del síndrome de efusión ciliocoroideo bilateral secundario a topiramato

A 45 year-old man with bilateral acute angle-closure and myopia after starting treatment with topiramate, secondary to alcohol and heroin dependence. Using Visante® OCT (Optical Coherence Tomography) and B-scan Ultrasound he was diagnosed with bilateral ciliochoroidal effusion as the pathophysiological mechanism. Topiramate was stopped and ocular hypotensive therapy with a topical cycloplegic and corticosteroids were started, resolving ciliochoroidal effusion syndrome.Visante® OCT and B-scan Ultrasound are useful tools for the diagnosis and follow-up of patients with acute angle-closure and myopia due to topiramate. As a result of broad spectrum of indications for topiramate, physicians and ophthalmologists should be aware of the possible ophthalmological manifestations attributable to this drug.     

Pentacam分析仪比较正常和高度近视眼前房深度和前房角的研究

目的：使用Pentacam三维眼前段分析仪比较高度近视眼与正常人（正视眼）中央前房深度（central anterior chamberdepth,CACD）和前房角（anterior chamber angle,ACA）两项前房参数差异,进一步了解高度近视眼的解剖学特点。方法：收集2010-10/2011-06在我院门诊就诊的正视眼82例,收集同期我院门诊与准分子激光中心就诊的高度近视眼68例,采用Pentacam三维眼前段分析仪测量CACD和ACA。对高度近视组与正视眼组的前房参数值进行两样本t检验,比较两组间参数有无差异。结果：Pentacam三维眼前段分析仪测得正常人CACD平均值为3.02±0.47mm,ACA平均值为33.26°±6.20°。高度近视眼的CACD平均值为3.24±0.38mm,ACA的平均值为39.55°±6.68°。高度近视眼与正视眼的两项前房参数值均存在显著性差异（均P〈0.05）。结论：Pentacam三维眼前段分析仪测量前房参数,高度近视眼与正视眼相比中央前房深度深、前房角宽。     

The development of experimental myopia and ocular component dimensions in monocularly lid-sutured tree shrews (Tupaia belangeri)

Tree shrews were monocularly deprived (MD) from the day of eye opening for periods of 15, 30, 45, 60 and 75 days. The initial structural change after 15 days of MD was a flattening of the corneal curvature in the deprived eye causing a hyperopic increase in refraction, relative to the fellow control eye. A relative myopia was first observed after 30 days of deprivation and increased as the length of MD increased. Animals monocularly deprived for 75 days consistently showed high degrees of myopia (greater -10 D). An increase in vitreous chamber depth was found after 30 days of deprivation and continued to increase, relative to the control eye, throughout the developmental period under investigation. There was a strong correlation (r = 0.84) between increase in vitreous chamber depth and the amount of experimentally-induced myopia. Anterior chamber depth was shallower in the deprived eyes of all animals. The crystalline lens was also consistently thinner in the deprived eye. Based on optical modeling, the observed myopia was consistent with the changes in ocular component dimensions. The susceptible period for experimental myopia begins about 15 days after eye opening.     

Angle-closure glaucoma secondary to topiramate use

CASE REPORT: We describe a 42 year-old patient who developed acute myopia and closed-angle glaucoma one week after beginning treatment with topiramate. Ultrasound biomicroscopy revealed a bilateral angle closure and choroidal effusion. The clinical findings resolved with withdrawal of the topiramate. DISCUSSION: Topiramate may cause acute myopia and closure angle glaucoma in some patients due to a choroidal effusion. Ultrasound biomicroscopy seems to be a useful tool for monitoring the progression of the clinical lesions and their resolution when the drug is withdrawn.     

Refractive errors,axial ocular dimensions,and age-related cataracts: the Tanjong Pagar survey

PURPOSE: To describe the relationship of refractive errors and axial ocular dimensions and age-related cataract. METHODS: Population-based, cross-sectional survey of ocular diseases among Chinese men and women aged 40 to 81 years (n = 1232) living in the Tanjong Pagar district in Singapore. As part of the examination, refraction and corneal curvature were determined with an autorefractor, with refraction further refined subjectively. Ocular dimensions, including axial length, anterior chamber depth, lens thickness, and vitreous chamber depth, were measured with an A-mode ultrasound device. Lens opacity was graded clinically according to the Lens Opacity Classification System (LOCS) III system. Refraction, biometry, and cataract data on right (n = 989) and left (n = 995) eyes were analyzed separately. RESULTS: In analyses controlling for age, gender, education, diabetes, and cigarette smoking, nuclear cataract was associated with myopia (-1.35 D vs. -0.11 D, P < 0.001, comparing right eyes with and without nuclear cataract), but not with any specific biometric component. Cortical cataract was associated with thinner lenses (4.67 mm vs. 4.79 mm, P = 0.001, comparing right eyes with and without cortical cataract), but not with refraction and other biometric components. Posterior subcapsular cataract was associated with myopia (-1.80 D vs. -0.39 D, P < 0.001, comparing right eyes with and without posterior subcapsular cataract), deeper anterior chamber (3.00 mm vs. 2.89 mm, P = 0.02), thinner lens (4.62 mm vs. 4.77 mm, P = 0.001), and longer vitreous chamber (15.78 mm vs. 15.57 mm, P = 0.09), but not with overall axial length and corneal curvature. Adjustment for vitreous chamber depth attenuated the association between posterior subcapsular cataract and myopia by 65.5%, but did not substantially change the association between nuclear cataract and myopia. CONCLUSIONS: These population-based data support the associations between nuclear and posterior subcapsular cataracts and myopia reported in previous studies. Posterior subcapsular cataract is also associated with deeper anterior chamber, thinner lens, and longer vitreous chamber, with vitreous chamber depth explaining most of the association between posterior subcapsular cataract and myopia.     

青少年近视在不同阅读距离调节状态下眼前段结构的变化

目的分析和探讨不同程度青少年近视在不同阅读距离诱导的调节状态下眼前段结构的变化。方法收集我院屈光门诊14～18岁间青少年近视95例（95眼），正视眼34例（34眼）作对照，其中男66例，女63例。所有被试者行主觉验光、调节幅度测定，眼前节OCT测量在不同阅读距离诱导的调节状态下（OD、3D、6D）的前房深度、晶状体厚度及瞳孔直径，采用SPSS11．5forWindows行统计学分析。结果①在调节放松情况下，随着近视度数增加，暗瞳直径明显减小（P〈0．05），各组间晶状体厚度差异无显著性，前房深度差异有显著性（P〈0．05）。（D随着阅读距离的减小，调节运用的增加，各组前房深度变浅值、晶状体厚度变厚值、暗瞳直径变小值均显著增加（P〈0．01）。③随着近视度数增高，诱发3D调节时前房深度变浅值显著增加（P〈0．01），晶状体厚度变厚值明显增加（P〈0．05），暗瞳直径变小值差异无显著性。④随着近视度数增高，诱发6D调节时前房深度变浅值显著增加（P〈0．01），晶状体厚度变厚值明显增加（P〈0．05），暗瞳直径变小值显著增加（P〈0．01）。结论在青少年中，随近视程度加深，阅读距离减小，运用调节量的增加可引起眼前房显著变浅，晶状体明显变厚：暗瞳直径缩小值在诱发6D调节时随近视度数增高而增大。     

Oseltamivir (Tamiflu)-induced bilateral acute angle closure glaucoma and transient myopia

A 27-year-old woman developed bilateral acute angle closure glaucoma (AACG) and transient myopia after taking oseltamivir for four days. On the fourth day, she received systemic and topical intraocular pressure (IOP)-lowering agents, and IOP decreased in both eyes. However, her visual acuity was unchanged. A myopic shift of -5.25 D OD and -5.0 D OS was estimated to have occurred in the acute phase. A-scan ultrasonography and Pentacam showed markedly shallow anterior chambers and increased lens thickness. Ultrasound biomicroscopy revealed an annular ciliochoroidal effusion with forward displacement of the lens-iris diaphragm. Ciliochoroidal effusion and transient myopia were resolved after discontinuation of oseltamivir.     

高度近视的屈光度影响因素多元线性回归分析

目的 分析高度近视眼屈光度的相关影响因素,明确高度近视眼患者的眼轴长度、角膜曲率、前房深度等因素与屈光度的关系.方法 对42例(77只眼)屈光度>-7.0D的高度近视眼患者进行研究,以前房深度、晶状体厚度、玻璃体腔深度、角膜曲率(K1/K2)、眼轴长度、角膜厚度,眼压为自变量,以等效球镜SE作为因变量,用多元线性同归模型筛选出有影响的因素,并比较各因素影响力的大小.采用SPSS 13.0统计软件进行多元线性逐步回归分析.结果 经相关分析,得到线性回归方程为:等效球镜(屈光度)=-39.558+1.141×眼轴长度+0.560×角膜曲率K2-1.515×前房深度-0.089×眼压.回归效果检验F=60.114(P<0.01).结论 眼轴长度、角膜曲率K2、前房深度,眼压对高度近视眼屈光度有明显影响,其中眼轴长度对高度近视眼屈光度影响显著.     

高度近视白内障超声乳化及低度数人工晶状体植入术

目的：评价高度近视白内障超声乳化及低度数人工晶状体植入术的疗效。方法：对84例128眼高度近视白内障施行巩膜隧道切口超声乳化,乳化时间平均201s,超声能量平均33．85,结果：术后1d,1wk,1mo视力≥0．4者分别为71．1％、75．8％、79．7％,术后3mo视力≥1．0者占22．6％,影响术后视力主要原因为高度近视近致眼底病变,主要并发症为角膜水肿（4．7％）、前房纤维素性渗出（1．65）及后囊膜破裂（2．3％）,结论：高度近视白内障超声乳化及低度数人工晶状体植入术,具有视力恢复良好、矫正屈光不正及预防视网膜脱离等优点,是高度近视白内障较理想的手术方式。