Hypertropia following Spontaneous Resolution of Brown's Syndrome

Purpose

To report a case of bilateral Brown''s syndrome with unilateral spontaneous resolution causing hypertropia and significant head tilt.

Case Report

A 3 ½-year-old girl presented with bilateral typical Brown''s syndrome and orthophoria in the primary position; she presented with unilateral resolution of right Brown''s syndrome 6 months later, causing right hypertropia and gradually deteriorating left head tilt. She benefited from right superior rectus muscle recession to help correct her head posture.

Conclusion

This is the first report of a patient presenting with known bilateral Brown''s syndrome with subsequent documented unilateral resolution causing a significant hypertropia of the resolved side and contralateral head tilt. Our case provides evidence in support of Clark and Noël''s [Can J Ophthalmol 1993;28:213–216] hypothesis that patients who present with unilateral Brown''s syndrome and contralateral inferior oblique muscle overaction might originally have had bilateral Brown''s syndrome with spontaneous resolution of 1 side only.Key Words: Brown''s syndrome, Hypertropia, Spontaneous resolution of Brown''s syndrome     

Familial Occurrence of Brown's Syndrome and Duane's Retraction Syndrome

Brown's syndrome and Duane's retraction syndrome are well-recognised patterns of incomitant ocular motility with the usual presentation in childhood. Both syndromes are typically sporadic but occasionally may be hereditary, particularly with Duane's retraction syndrome. This short report details the ocular findings in a single family unit showing autosomal dominant inheritance for Duane's retraction syndrome and reduced penetrance for Brown's syndrome with the unusual combination of both Brown's and Duane's retraction syndromes in two family members.     

A rare case of traumatic posterior phacocele with retinal detachment

Dislocation of crystalline lens into the anterior subconjunctival or subtenon''s space is a rare but known complication of blunt trauma. Dislocation into the posterior subtenon''s space is even rarer and can be associated with a complication such as occult scleral tear and retinal detachment. We report a case of traumatic posterior subtenon''s dislocation of crystalline lens after blunt trauma and its successful surgical management.     

Reemergence of syphilitic uveitis masquerading as other diseases: a report of two cases

During a 6-month period in 2010, 2 patients with uveitis were examined at our department and diagnosed with ocular syphilis. They initially presented with symptoms and signs resembling Harada''s disease and Behçet''s disease and were therefore treated with systemic steroids with suboptimal responses. When laboratory workup revealed neurosyphilis, they were given a course of intravenous penicillin G, which led to significant clinical and visual improvement. Epidemiological data indicates a worldwide reemergence of syphilis and a high degree of suspicion is necessary in view of its multitude of presenting ocular signs without pathognomonic features.Key Words: Neurosyphilis, Uveitis, Harada''s disease, Behçet''s disease     

Histopathological reporting of corneal pathology by a biomedical scientist: the Sheffield Experience

Aims

The advanced specialist diploma in ophthalmic pathology was jointly ratified by the Royal College of Pathologists and the Institute of Biomedical Science in 2008. It results in extended roles for suitably qualified Biomedical Scientists (BMSs) in ophthalmic pathology specimen dissection and histological reporting of selected specimens, specifically non-neoplastic corneas. This study aimed to examine the reporting of corneal histology by a BMS training towards this diploma in comparison with a Consultant Ophthalmic Pathologist.

Methods

This report covers a non-interventional, prospective examination of BMS''s diagnostic skills. After 6 months training, 50 consecutive corneal cases were reported by the BMS and the same case reported by the consultant ophthalmic pathologist. The BMS''s diagnosis was compared with the final consultant''s diagnosis. This exercise was then repeated after 24 months of training.

Results

After 6 months, the BMS''s diagnoses matched the consultant diagnoses in 44/50 (88%) cases. After 24 months, the BMS''s diagnoses matched the consultant diagnoses in 48/50 (96%) of cases.

Conclusions

The results indicate that BMS''s reporting of corneal histology is a real and safe possibility. Furthermore, it indicated deficiencies in BMS''s diagnostic skills to inform further training/knowledge acquisition.     

前节OCT在内眼术后角膜后弹力层脱离诊治中的应用

目的:探讨前节OCT(AS-OCT)在内眼术后角膜后弹力层脱离诊治中的临床应用价值。方法:回顾性分析2016-06/2019-04我院眼科行内眼术后发生角膜水肿的患者21例23眼,均采用AS-OCT检查观察角膜水肿程度及角膜后弹力层脱离情况。对于轻度及以上角膜后弹力层脱离者应用前房注气法复位,余角膜水肿者予以药物保守治疗,随访观察角膜水肿及后弹力层贴附情况。结果:本研究纳入患者21例23眼内眼术后均有不同程度角膜水肿,14眼角膜后弹力层脱离,其中11眼轻度及以上角膜后弹力层脱离予以前房注气后1d复查AS-OCT,10眼后弹力层贴附良好,1眼贴附欠佳,再次注气后贴附良好。随诊1mo,所有患者角膜均恢复透明,视力恢复良好。结论:AS-OCT能够及时、准确诊断和评估角膜后弹力层脱离及其治疗效果。     

The Effect of Infliximab Therapy on Maculopathy in Behcet's Panuveitis: A Case Report

Aim

To report a case of Behcet''s panuveitis and unilateral inflammatory maculopathy which was refractory to conventional immunosuppressive therapy but responded well to long-term treatment with the tumor necrosis factor-alpha inhibitor infliximab.

Methods

Reporting the effect of intravenous infliximab infusion therapy for 54 weeks in a case of Behcet''s panuveitis and unilateral inflammatory maculopathy. The patient''s best corrected visual acuity was monitored, and biomicroscopic and fundus examinations as well as macular thickness map analysis by stratus optical coherence tomography were performed.

Results

The best corrected visual acuity in his right eye improved after the resolution of inflammatory signs on biomicroscopic and fundus examinations as well as on stratus optical coherence tomography macular thickness analysis reports. No significant systemic side effects were noted.

Conclusions

Long-term therapy with infliximab is effective and safe for refractory inflammatory maculopathy in Behcet''s disease. We report this case to contribute to the few previously reported cases showing the beneficial effect of long-term infliximab therapy for Behcet''s panuveitis. In conclusion, early initiation of infliximab therapy for inflammatory maculopathy in Behcet''s disease preserves and improves visual acuity.Key words: Behcet''s panuveitis, Infliximab therapy, Inflammatory maculopathy, Visual acuity     

Swept-Source Optical Coherence Tomography Detecting Intraoperative Acute Descemet's Fold Formation

BackgroundTo present an intraoperative acute Descemet''s fold formation using swept-source optical coherence tomography (SS-OCT) imaging.ConclusionThe stromal fold might be due to the focal bulge of the stroma posteriorly caused by the rapid volume increase of the stroma which could push Descemet''s membrane posteriorly, thereby forming a wavy Descemet''s membrane layer.Key Words: Optical coherence tomography, Swept-source optical coherence tomography, Descemet''s membrane, Descemet''s fold     

白内障术后角膜后弹力层脱离的临床观察

目的：探讨白内障超声乳化联合人工晶状体植入术及白内障囊外摘除联合人工晶状体植入术所致角膜后弹力层脱离的原因及有效诊疗方法。

方法：回顾性分析2015-01/2017-12在我院行白内障超声乳化联合人工晶状体植入术或白内障囊外摘除联合人工晶状体植入术的2 006例2 069眼,对术中或者术后发生角膜后弹力层脱离的26例26眼患者的诊疗及预后进行临床观察。

结果：发生不同程度角膜后弹力层脱离的26例26眼患者经相应治疗,未发生角膜内皮失代偿。角膜水肿消退,恢复透明,视力不同程度地提升。UBM检查证实后弹力层复位。

结论：白内障术中术后及时发现,根据不同情况选择合适的治疗方法,是治疗白内障术后角膜后弹力层脱离,恢复患者视力的关键。     

比较超声乳化术中林格液和乳酸盐林格液对角膜内皮细胞的影响

目的：比较林格液和乳酸林格液(RL)在超声乳化术中作为冲洗液的差异,并探讨其对角膜内皮细胞的影响。

方法：这是一项前瞻性介入性双盲临床研究,包括100例(100眼)年龄在50～65岁之间的年龄相关性白内障患者。随机分为两组(每组各50眼)。组1使用林格液,组2使用乳酸盐林格液冲洗液。

结果：组1患者平均年龄57.5±8岁,组2患者平均年龄58.6±9岁。3mo后,组1内皮细胞密度平均下降8.5%,组2平均下降3.6%(P=0.013)。此外,组1中央角膜厚度平均增加6.9%,组2平均增加1.5%(P=0.006)。通过将测厚仪和高光显微镜参数的变化率与灌水量相关联得出两者间无显著相关性。

结论：与乳酸盐林格液相比,使用林格液作为冲洗液可减少术后内皮细胞的损失,也可减轻术后水肿。     

眼睑痉挛型Meige综合征的治疗进展

Meige综合征是一种节段性的颅颈部肌张力障碍性的锥体外系疾病,属于成人多动症的一种。发病原因不明,常见于中老年女性,多与抑郁、外伤、药物、手术等危险因素相关,眼睑痉挛是Meige综合征最早也是最常见的临床症状,尽管有自发缓解的可能,但亦有致盲风险,临床上多因对此病认识不足而延误治疗影响预后,随着其发病率的增长,尤其以眼睑痉挛就诊于眼科的人数增长,全面认识Meige综合征有利于提高眼科医师诊治本病的能力以及指导临床合理用药。本文就眼睑痉挛型Meige综合征的治疗进展予以综述,总结了药物、手术和中医疗法的利弊,以期提高眼科医师对此类疾病的诊治水平。     

光照对屈光发育的影响研究

在当今社会,由于遗传因素和环境因素共同作用,儿童青少年近视发病率正在急剧增加。尽管有遗传因素的影响,但有诸多研究表明环境因素在其中起着至关重要的作用,其中户外活动已被证实是降低儿童近视发病率的主要保护因素。在户外活动中的诸多因素中,光照又是其中的重要因素之一。不同的光照环境,如光照的强度、波长、时间、节律等都可以影响眼球的屈光发育。本文总结了近年来光照对眼球屈光发育的临床与动物实验的研究成果,为进一步探究屈光不正发生发展机制及防治策略提供参考。     

A Case of Bilateral Descemet's Membrane and Subepithelial Opacity: In vivo Laser Confocal Microscopic Study

Purpose

To report the in vivo laser confocal microscopy findings from a patient with Descemet''s membrane and subepithelial opacity OU.

Case Report

A healthy 41-year-old male with Descemet''s membrane and subepithelial opacity OU was studied. Routine ophthalmic examination, standard slit-lamp biomicroscopy, and in vivo laser confocal microscopic analysis of the entire corneal layer were performed. Slit-lamp biomicroscopy revealed subepithelial opacity in the mid-peripheral to peripheral cornea and numerous opacities located at the level of Descemet''s membrane. It was difficult to distinguish the precise histological location of the opacity. In vivo laser confocal microscopy showed numerous hyperreflective particles in the subepithelium to superficial stroma and hyperreflectivity of Descemet''s membrane. No abnormalities could be detected in the epithelial cell layer, midstromal layer, deep stromal layer, or endothelial cell layer.

Conclusion

Although the origin of the corneal opacities was unclear, in vivo laser confocal microscopy was useful for observing microstructural abnormalities in a case of Descemet''s membrane and subepithelial opacity.Key words: Descemet''s membrane opacity, Subepithelial opacity, Confocal microscopy     

帕金森患者视网膜神经纤维层与神经节细胞复合体的改变

目的：观察帕金森患者视网膜神经纤维层厚度(peripapillary retinal nerve fiber layer thickness,pRNFL)及黄斑区神经节细胞复合体( ganglion cell colplex,GCC)厚度的变化特点。
　　方法：选取2014-07/2015-05北京天坛医院收治的原发性帕金森病( Parkinson’s disease,PD)患者40例80眼,正常对照组30例60眼,使用频域相干光学断层扫描( optic coherence tolography,OCT)对所有受试者进行检查,分别测量眼底pRNFL和GCC厚度。用独立样本t检验比较帕金森组与正常对照组之间各个象限pRNFL厚度的差异,并分析帕金森组的 pRNFL 厚度与 GCC 厚度(包括 Avg、Sup和Inf厚度)的相关性。
　　结果：帕金森组与正常对照组比较, pRNFL 的上方颞侧(ST)、上方鼻侧(SN)、下方鼻侧(IN)、颞侧上方(TU)、下方颞侧( IT )、颞侧下方( TL )象限、pRNFL 上方厚度( Sup)、下方厚度( Inf)和平均厚度( Avg)均具有统计学差异( P<0.05);帕金森组GCC厚度与正常对照组相比,平均厚度、上方和下方厚度均具有统计学差异(P<0.05);并与pRNFL均呈明显正相关(平均：r=0.743, P=0.01;上方：r=0.689,P=0.01;下方：r=0.693,P=0.01)。
　　结论：帕金森患者pRNFL厚度及GCC厚度均较正常人群明显变薄,两者呈正相关。     

Investigation of amplitude of accommodation among Ghanaian school children

Background: Deficient amplitude of accommodation is the most frequently used criteria in an optometric practice in diagnosing whether a patient has accommodative insufficiency. This deficiency is determined based on an age‐related expected finding calculated using Hofstetter's equation derived from Donder's and Duane's data. The aim of the present study was to investigate the amplitude of accommodation among Ghanaian school children and to compare the findings with age‐expected norms predicted by Hofstetter's equation. Methods: The amplitude of accommodation was measured using the push‐up method in a random sample of 435 school children from the Cape Coast Municipality. The mean amplitude of accommodation was compared with the age‐expected amplitude of accommodation as predicted by Hofstetter's equation for average amplitude of accommodation. Results: The mean amplitude of accommodation was 16.86 ± 3.07 D (95% CI = 16.57, 17.15). This is significantly higher than age‐expected norms calculated using Hofstetter's equation. The amplitude of accommodation showed the characteristic decline with age. Conclusion: From the results, we conclude that the age‐expected norms for amplitude of accommodation using Hofstetter's equation might not be accurate for Ghanaian children.     

Difference in Myopic Proportion Among three Populations

Data from three studies, New England, Alaska, and Mid-south, were analyzed for significant difference in myopic proportion among these populations. Difference between the Mid-south adjusted to New England's full age range of 50 and Alaska's upper age limit of 45 is not significant, meaning that the same data adjusted to two slightly discrepant age intervals at both ends are comparable. Difference between New England's and Alaska's is not significant, showing evidence to deny Young et al's unsupported claim of higher myopic proportion in Eskimos than it Is in whites. But the difference between Mld-south's and New England's or Alaska's is significant. Thus, different genetlcal, socio-economical and environmental factors are insufficient to account for these similarity and difference in myopic proportion among these populations.     

Ophthalmic complications including retinal detachment in hyperimmunoglobulinemia E (Job's) syndrome: Case report and review of literature

Hyperimmunoglobulinemia E (Job''s) syndrome is characterized by markedly increased levels of immunoglobulin E, recurrent cutaneous and systemic pyogenic infections, atopic dermatitis, and peripheral eosinophilia. Although ocular involvement in Job''s syndrome is rare, there are reports of keratoconus, staphylococcal chalazia with blepharitis, and Candida endophthalmitis by various authors. We present the first case report of retinal detachment with complicated cataract in Job''s syndrome.     

Inflammatory bowel disease (Crohn's disease) in a Spanish patient with pars plana exudates: Report of a new case and review of the literature

Several ocular manifestations have been found in Crohn's disease patients, most often affecting the anterior segment. This paper presents the case of a young woman with pars plana exudates in whom Crohn's disease was later diagnosed. To the authors' knowledge, this is only the second report of Crohn's disease and concomitant pars plana exudates.     

Evaluation of Behçet's uveitis with gallium-67 scintigraphy

The role of gallium-67 scintigraphy in Behçet's uveitis was evaluated. Pattern and quantitative comparisons were made in patients with active Behçet's uveitis, uveitis in remission, and ocular sarcoidosis. There were statistically significant differences between groups. Our data suggest the persistence of inflammatory cells even in remission stages of Behçet's uveitis. In the presence of certain patterns, gallium-67 scintigraphy can make limited contributions in the evaluation of Behçet's disease or sarcoidosis.     

Interference of Descemet's Membrane with Aqueous Humor Drainage via an ExPRESS Mini Shunt

Purpose

To describe a case in which Descemet''s membrane interfered with aqueous humor drainage through an ExPRESS mini shunt. This problem was successfully solved by Nd:YAG laser membranotomy.

Case Report

A 70-year-old male, diagnosed with corticosteroid-induced glaucoma in his right eye, presented to our hospital. Topical betamethasone treatment was discontinued, and the patient was treated with intravenous D-mannitol and acetazolamide, followed by oral acetazolamide, oral potassium L-aspartate, topical dorzolamide hydrochloride, topical carteolol hydrochloride, and topical latanoprost. However, his right intraocular pressure (IOP) remained elevated. We performed ExPRESS shunt surgery in the patient''s right eye. His postoperative IOP was initially within the normal range, but it reincreased 1 month after surgery. We found that the Descemet''s membrane was interfering with both the primary (axial) and reserve orifices at the tip of the ExPRESS mini shunt. Nd:YAG laser membranotomy was performed and the patient''s IOP again improved without any other medical treatment.

Conclusion

Descemet''s membrane interfered with aqueous humor drainage via ExPRESS mini shunt, causing an increased IOP, which was resolved by Nd:YAG laser membranotomy.Key words: Corticosteroid-induced glaucoma, Descemet''s membrane, ExPRESS mini shunt