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ABSTRACT: BACKGROUND AND PURPOSE:High-resolution MR imaging enables direct imaging of the ocular motor nerves. The aim of this study was to assess the various causes of congenital or developmental neuropathic strabismus by using high-resolution MR imaging.MATERIALS AND METHODS:High-resolution MR imaging was performed to evaluate the ocular motor nerves (CNIII, CNIV, CNVI) in 247 consecutive patients with suspected congenital or developmental neuropathic strabismus. These MR images, along with those obtained from conventional MR imaging of the brain and the orbit, were evaluated.RESULTS:MR imaging abnormalities were found in 112 patients: ocular motor nerve abnormalities in 98 patients (88%), orbital abnormalities in 9 patients (8%), and brain abnormalities in 5 patients (4%). Ocular motor nerve abnormalities were CNIV aplasia (63%), CNVI aplasia or hypoplasia (21%), CNIII aplasia or hypoplasia (3%), and combined CNIII aplasia and CNVI hypoplasia (1%). Orbital abnormalities were EOM hypoplasia (7%), EOM hypertrophy (1%), and fibrotic mass (1%). Brain abnormalities were periventricular leukomalacia (4%) and periventricular heterotopia (1%).CONCLUSIONS:Various MR imaging abnormalities were associated with congenital and developmental neuropathic strabismus. The most common abnormality was CNIV aplasia.
American Journal of Neuroradiology 05/2012; · 2.93 Impact Factor
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ABSTRACT: The cisternal segment of the trochlear nerve is difficult to identify reliably by routine MR imaging. We investigated the visibility and anatomic features of the trochlear nerve by using high-resolution 3D-bTFE imaging in healthy subjects.
This study was conducted with 32 healthy subjects without ocular movement disorders. For us to visualize the cisternal segment of the trochlear nerve, all subjects underwent 3D-bTFE imaging at 3T with 2 different resolutions: conventional resolution (voxel size, 0.67 x 0.45 x 1.4 mm) and high resolution (voxel size, 0.3 x 0.3 x 0.25 mm). Visibility of the trochlear nerve was graded with the use of a qualitative scale of certainty as follows: definite, probable, and indeterminate. The diameter of the trochlear nerve was measured.
On conventional-resolution images, the visibility of the trochlear nerve was definite in 3 nerves, probable in 12 nerves, and indeterminate in 49 nerves. On high-resolution images, visibility was definite in 63 nerves and probable in 1 nerve. The mean diameter of the trochlear nerve was 0.54 mm (range, 0.35-0.96 mm).
The trochlear nerve was visualized 100% of the time on high-resolution imaging with a voxel smaller than the nerve diameter. High-resolution imaging should have an important role in investigating the pathogenic mechanism of neuropathic strabismus, such as congenital superior oblique palsy.
American Journal of Neuroradiology 06/2010; 31(6):1076-9. · 2.93 Impact Factor
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ABSTRACT: To compare retinal nerve fibre layer (RNFL) thickness changes between mitochondrial DNA (mtDNA) mutations at nucleotides 11778 and 14484 in Leber's hereditary optic neuropathy (LHON) using optical coherence tomography (OCT).
Thirty LHON patients with mtDNA mutations at nucleotides 11778 or 14484 underwent full ophthalmologic examinations including Stratus OCT. Patients were divided into four groups according to disease duration (early <or=6 months, late >6 months) and mtDNA mutation type (11778 and 14484), and their RNFL thicknesses were compared.
Average RNFL thickness in the early 11778 group was significantly greater than that in the early 14484 group (P=0.04). Average RNFL thickness in the late 11778 group was significantly less than that in the late 14484 group (P=0.02). Quadrant analysis of the superior, nasal, and inferior quadrant RNFL thickness in the late 11778 group showed more severe RNFL atrophy than in the late 14484 group (P=0.023, 0.015, 0.003, respectively).
RNFL thickness was significantly increased in the early stage and decreased in the late stage in the 11778 group than in the 14484 group.
Eye (London, England) 02/2009; 24(1):107-11. · 1.97 Impact Factor
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ABSTRACT: To assess the efficacy of prismatic correction of residual esotropia <or=20 prism dioptres (PD) after full hypermetropic correction in patients with partially accommodative esotropia.
Medical records of 64 patients who received prismatic correction for residual esotropia </=20 PD were reviewed. Outcomes were considered successful if patients maintained orthotropia or esophoria for at least 1 year and did not require surgery. Factors including age, sex, visual acuity, refractive errors, amount of deviation, sensory status, and the presence of amblyopia were analysed and compared between the success and failure groups.
Prismatic correction was successful in 28 of 64 patients (44%). The success group showed better results both with Worth 4-dot test (P=0.001 at distance and P=0.046 at near) and Randot stereo test (P=0.003 for dots and P=0.000 for animals). Success rate increased to 58% without amblyopia, 72 and 93% with normal fusional response at near and at distance with Worth 4 dot test respectively, and 92% with stereoacuity of 800 s of arc or better. In all patients in success group, fusion and stereoacuity improved or maintained during follow-up.
Prismatic correction was successful in 44% of the patients with residual esotropia <or=20 PD and the success group showed an improved or stable sensory status with time. With a baseline fusion on Worth 4-dot test or stereopsis of 800 s of arc or better, prismatic correction could be considered as the first-line treatment.
Eye (London, England) 01/2009; 23(11):2052-5. · 1.97 Impact Factor
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ABSTRACT: The Heimann-Bielschowsky phenomenon (HBP) refers to coarse vertical oscillation of the eye with impaired vision. The ocular movements are strictly monocular, occurring only in the eye with amblyopia. The vertical oscillation is of equal velocity in both vertical directions, or may sometimes be greater in the downward than upward direction. HBP develops several years after loss of vision. It can be differentiated from dissociated nystagmus in spasmus nutans, congenital nystagmus and internuclear ophthalmoplegia based on the strict unilaterality, vertical direction and low frequency. Previously, only a few reports described the development of oscillopsia due to HBP after cataract surgery, which resolved spontaneously or responded to gabapentin. However, visual impairments due to diplopia or oscillopsia from HBP after cataract surgery have received little attention. We report a man who developed persistent vertical diplopia and oscillopsia due to HBP after a cataract operation, which markedly impaired his vision.
The British journal of ophthalmology 11/2008; 92(10):1402. · 2.92 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the prevalence and patterns of refractive errors and strabismus in Asian patients with Down syndrome, as they relate to age.MethodsA total of 261 Korean patients with Down syndrome were examined between March 1999 and May 2007. Eighty-nine patients were excluded from the study. The remaining 172 patients were divided into four age groups (<3 years, 3-<6 years, 6-<9 years, and >or=9 years). Full ophthalmologic examinations and strabismus assessments were performed. Refractive errors were defined as follows: myopia >or=-1.00 D, hyperopia >or=+1.00 D, astigmatism >or=+/-1.00 D, and anisometropia as a refractive difference between the two eyes >or=1.00 D.
Hyperopia (46.5%) was slightly more common than myopia (40.1%). The prevalence of myopia increased with age, whereas that of hyperopia decreased. Astigmatism was found in 66.8% of patients, and astigmatism >or=2 D was found in 16.8% of patients. Anisometropia was identified in 29.7% of patients, and the incidence of anisometropia correlated significantly with age as well as with astigmatism. Esotropia (22.1%) was twice as common as exotropia (10.5%). The prevalence of esotropia increased with age, but that of exotropia decreased. Fifty patients were found to have nystagmus (29.1%).
In Asian patients with Down syndrome, esotropia was more common than exotropia and hyperopia was more common than myopia. The prevalence of exotropia and astigmatism was much higher in this study than has been previously reported.
Eye (London, England) 10/2008; 23(7):1560-4. · 1.97 Impact Factor
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ABSTRACT: Clinical features of acquired third, fourth, and sixth cranial nerve palsy showed variation among previous studies. Evaluation of natural course with objective criteria will establish accurate recovery rates and important factors for recovery.
Retrospective chart review was performed on 206 patients who visited a neuro-ophthalmic department with acquired third, fourth, and sixth nerve palsy. Aetiology and results of ocular exam on each visit were reviewed, and multivariate logistic regression analysis was performed to identify independent factors affecting recovery.
The sixth cranial nerve was affected most frequently (n=108, 52.4%) and vascular disease (n=64, 31.1%) was the most common aetiology. Recovery was evaluated with change of deviation angle for 108 patients, who were first examined within a month of onset and followed up for at least 6 months. Ninety-two (85.2%) patients showed overall (at least partial) recovery and 73 (67.6%) showed complete recovery. In univariate analysis, initial deviation angle was found to be only significant factor associated with complete recovery (P=0.007) and most patients who experienced successful management of treatable underlying disease showed recovery.
With objective criteria based on deviation angle, overall recovery rate from the third, fourth, and sixth nerve palsy was 85.2%. Patients who had smaller initial eyeball deviation or successful management of treatable underlying disease had a high chance of recovery.
Eye 06/2008; 22(5):691-6. · 1.85 Impact Factor
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ABSTRACT: To investigate the incidence of asystole during strabismus surgery. Design: Retrospective, noncomparative interventional case series. Methods: Six months to 80 years of age of 3628 consecutive patients who underwent strabismus surgery from October 1994 to May 2007 were enrolled.
Four patients (0.11%) under general anaesthesia showed asystole during strabismus surgery. All four were adults of 28, 32, 50, and 53 years of age. Two patients had hypertension and three had preoperative electrocardiographic abnormalities. Three patients had previously undergone uneventful strabismus surgery.
Asystole is likely to be encountered during strabismus surgery with an incidence of ca. 0.11%.
Eye (London, England) 06/2008; 23(4):864-6. · 1.97 Impact Factor
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ABSTRACT: To report optical coherence tomography (OCT) finding in a patient with tobacco-alcohol amblyopia.
A 45-year-old man presented with a gradual decrease in vision over 4 years. He had smoked a half to one pack of cigarettes per day and had consumed 350 cc of gin per day for 30 years. A detailed ophthalmologic examination was performed.
His corrected visual acuities were 20/800 OD and 20/200 OS. A Goldmann visual field examination showed ceco-central scotomas in both eyes. OCT using a peripapillary Fast RNFL (retinal nerve fiber layer) programme showed a small decrease in the RNFL thickness of the superotemporal quadrant in the normative diagram of the right eye in spite of a markedly increased RNFL thickness in both eyes.
During the phase of visual loss in a patient with tobacco-alcohol amblyopia, visual loss may precede optic disc changes as detected by OCT.
Eye 04/2008; 22(3):469-70. · 1.85 Impact Factor
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ABSTRACT: To develop an intraoperative, extraocular Indocyanine Green dye staining test (IE-ICG) for the differentiation of a peeled ILM from a thin epiretinal membrane, and to evaluate its efficacy.
This was a consecutive observational case and laboratory observational series. We performed ILM peeling in patients with an idiopathic macular hole (MH, n = 10) and diabetic macular oedema (DME, n = 10) without vital dye staining such as ICG or Trypan Blue. We also performed membrane peeling in patients with an idiopathic epiretinal membrane (ERM, n = 10). Then, the peeled membranes were stained with ICG (1.25 mg/ml) beyond the operation field and examined under a light microscope. After this examination, membranes were fixed with glutaraldehyde, and an electron microscope was used to confirm whether they were ILMs or thin ERM. The concordance rates between surgeon's intraoperative impression of membranes (SI), IE-ICG results (IT) and histological findings (HF) of peeled membranes were evaluated to reveal the efficacy of IE-ICG.
The ILMs were homogenously stained with ICG dye (positive IE-ICG), and the ERMs were not stained at all by ICG dye (negative IE-ICG). The concordance rate between IT and HF was 100% in all three groups of patients. However, concordance rates between SI and IT were 100% in MH, 80% in DME and 50% in ERM, respectively. The surgeon's impression of the membrane is inaccurate, especially in patients with idiopathic epiretinal membrane.
Considering the cost, difficulties of tissue preparation, and the time-consuming process of histological confirmation of an ILM, IE-ICG may be a useful alternative for the differentiation of a peeled ILM and a thin ERM.
The British journal of ophthalmology 04/2008; 92(3):369-72. · 2.92 Impact Factor
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ABSTRACT: The surgical success rates for intermittent exotropia of the convergence insufficiency type have been reported to be variable, and most were studied retrospectively in adults. The purpose of this study was to evaluate prospectively the long-term surgical results of unilateral lateral rectus (LR) muscle recession and medial rectus (MR) muscle resection in children with intermittent exotropia of the convergence insufficiency type.
A total of 14 children with intermittent exotropia greater at near than at distance by 10 prism diopters (PD) or more were included in this prospective study. The amounts of resection and recession were based on near and distance deviation, respectively. Minimum follow-up was 1 year (mean 26.6 months; range, 12-68 months) after surgery. The paired t-test was used to compare preoperative and postoperative measurements of the angle of deviation at distance and near, near-distance difference.
Significant postoperative reduction was achieved in terms of mean distance exodeviation, from 22.5 PD to 9.1 PD (P=0.000), and mean near exodeviation from 33.8 PD to 13.6 PD (P=0.000). Mean near-distance difference reduced from 11.3 PD preoperatively to 4.6 PD postoperatively (P=0.000). Fresnel prism was used temporarily to treat postoperative esotropia in only one patient for postoperative 6 months.
Unilateral surgery biased to MR strengthening more than LR weakening in children with intermittent exotropia of the convergence insufficiency type, was found to successfully reduce both distance and near deviation and to collapse near-distance differences with a low risk of long-term postoperative esotropia.
Eye 04/2007; 21(3):344-7. · 1.85 Impact Factor
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ABSTRACT: To evaluate the long-term results of slanted medial rectus (MR) resection for intermittent exotropia (X(T)) of the convergence insufficiency type.
In all, 10 patients with an X(T) greater at near than at distance by 10 prism diopters (PD) or more were included in this prospective study. Patients received slanted bilateral MR resection. The upper edge of the MR was resected according to the distance exodeviation and the lower edge of the MR was resected according to near exodeviation. The postoperative follow-up period was between 6 and 62 months with a mean of 38.9 months. The paired t-test was used to compare: mean distance angle of deviation preoperatively and postoperatively; mean near angle of deviation preoperatively and postoperatively; and mean near-distance exodeviation difference preoperatively and postoperatively.
Bilateral slanted MR resections reduced mean exodeviation at distance from 23.0+/-7.2 to 16.3+/-5.4 PD (P=0.03); mean exodeviation at near from 34.3+/-7.7 to 24.6+/-6.9 PD (P=0.01); and mean near-distance difference from 11.4+/-2.6 to 8.3+/-3.5 PD (P=0.04). At the final follow-up examination, all patients demonstrated an exodeviation of 10 PD or more at distance and near, and the exodeviation difference between distance and near deviation was within 10 PD in five of the 10 patients. Three patients had an esodeviation at distance after surgery, but all resolved within 4 weeks.
Bilateral slanted MR resections in patients with X(T) of the convergence insufficiency type resulted in undercorrection in all patients.
Eye 12/2006; 20(11):1279-83. · 1.85 Impact Factor
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ABSTRACT: Few reports have included large numbers of exotropia patients. Thus, we undertook this study to perform a survival analysis of over 350 patients with exotropia and to determine which factors might affect the outcome of exotropia surgery.
The clinical records of 365 patients who underwent exotropia surgery by one surgeon were retrospectively reviewed. Preoperative patient characteristics, surgical procedures performed, and early postoperative ocular alignment were evaluated as potential risk factors of surgical outcome using survival analysis.
The estimated median time from surgery to recurrence was 48.3 months. None of the characteristics or procedures were found to be significantly associated with surgical outcome. The likelihood of a good postoperative surgical outcome was highest with an initial postoperative alignment of more than 10 prism diopters of esotropia (P<0.001).
Early postoperative overcorrection was the only predictor of a successful long-term outcome after exotropia surgery.
Eye 11/2006; 20(11):1268-72. · 1.85 Impact Factor
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Journal of Neurology 02/2006; 253(3):390-391. · 3.47 Impact Factor
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ABSTRACT: To retrospectively evaluate the incidence of cyclodeviation among patients with diplopia and analyse the causative diseases and clinical manifestations of cyclodeviation.
The medical records of 266 consecutive patients of 15 years of age or older presenting with diplopia, who had undergone the Lancaster red-green test (LRGT) from January 2001 to December 2002, were retrospectively reviewed. The presence of cyclodeviation on LRGT, predisposing conditions, causative diseases, and clinical manifestations of cyclotropia were analysed. Cyclodeviation on the LRGT were compared with those from the Maddox double-rod test (MDRT) and fundus photography.
A total of 63 (24%) out of 266 patients exhibited cyclodeviation on LRGT. Eight out of 63 patients with cyclodeviation on the LRGT complained of torsional diplopia. Superior oblique palsy (SOP) was the most common causative disease (42 patients), followed by skew deviation (six) and thyroid orbitopathy (three). Excyclodeviation was found in 57 patients and incyclodeviation in four patients on the LRGT. The spontaneous recovery rate was 83% in patients of vascular origin and 17% of traumatic origin. Cyclodeviation with the MDRT and fundus photography showed good correlation with those obtained from the LRGT. There was no association of the amount of cyclotropia with the presence of torsional diplopia as well as with its recovery.
In spite of the rare complaint of torsional diplopia, 24% of the patients with diplopia showed cyclodeviation on the LRGT. SOP was the most common causative disease. Most of the patients with cyclodeviation of a vascular origin showed spontaneous improvement.
Eye 09/2005; 19(8):873-8. · 1.85 Impact Factor
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ABSTRACT: To evaluate the safety of the approach based on the notion that the surgical dose for intermittent exotropia should be based on the largest angle ever measured.
Prospective case series of 33 patients.
A total of 33 patients with intermittent exotropia, in whom angles of misalignment at distance or near showed a difference of 15 prism diopters (PD) or more among visits, were included. All the patients were treated by bilateral lateral rectus recession by the same surgeon (JMH), and all were followed up for a minimum of 6 months postoperatively. Short- and long-term surgical results after the initial procedure for intermittent exotropia were analysed.
The short-term average result at a postoperative 1 week was 9.3 PD esotropia at distance (range 30 esotropia-16 exotropia). The long-term average results postoperative 6 or 9 months were 4.8 PD exotropia at distance (range 12 esotropia-30 exotropia). At the last follow-up, no overcorrection over 2 PD esophoria at distance was found, and 9 PD of intermittent esotropia and esophoria at near was observed in two patients, respectively.
The strategy of surgical dose for intermittent exotropia based on the largest angle ever measured did not result in overcorrections and is believed to be safe.
Eye 07/2005; 19(6):637-42. · 1.85 Impact Factor
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ABSTRACT: Autosomal dominant optic atrophy (ADOA) is the commonest form of inherited optic neuropathy. Mutations in the OPA1 gene encoding a dynamin-related mitochondrial protein underlie ADOA and may perturb the biogenesis and maintenance of mitochondria.
To investigate the mutation spectrum of the OPA1 gene and assess alterations in mitochondrial content caused by OPA1 mutations.
Sixteen Korean patients with clinically suspected ADOA were studied. The mutation spectrum of the OPA1 gene was analyzed by PCR single-strand conformation polymorphism and sequencing, and mitochondrial DNA (mtDNA) content was quantified by real-time PCR.
Eight different mutations were found, including five novel mutations. Quantitative real-time PCR analysis showed excellent linearity and precision for the determination of mtDNA copy numbers. The number of mtDNA copies per cell in patients with OPA1 gene mutations (ages 7 to 40) was significantly lower than those in all normal control subjects (p = 0.037), particularly lower than in normal control subjects ages 10 to 39 (p = 0.022).
The mutation spectrum of the OPA1 gene disclosed marked genetic heterogeneity and the mitochondrial DNA content was found to be lower in autosomal dominant optic neuropathy, which provides direct evidence for a pathogenetic role of mutations of the OPA1 gene.
Neurology 04/2005; 64(6):966-72. · 8.31 Impact Factor
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Eye 01/2005; 20(1):122-123. · 1.85 Impact Factor
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ABSTRACT: To determine the effect of polyurethane film with sustained release dexamethasone (SRD) in delayed adjustable strabismus surgery.
A prospective, masked observer, controlled study was performed in rabbits. Thirty four rabbit eyes were divided into three groups. After recession of the superior rectus muscle (SRM), polyurethane film with or without SRD, or balanced salt solution was applied beneath and over SRM in the polyurethane-dexamethasone group (group P-D), polyurethane group (group P), and the control group (group C), respectively. Delayed adjustment was performed once on each SRM at 4 and 6 weeks postoperatively by a masked observer. The possible length to adjust and the necessary force required for the adjustment, as well as the degree of any adhesions, were also evaluated.
In the control group, adjustment was impossible in all of the eyes at 4 and 6 weeks postoperatively. In group P-D, adjustment was possible in 11 out of 11 eyes (11/11) 4 weeks postoperatively and in 10/11 eyes 6 weeks postoperatively. In group P, adjustment was possible in 9/11 eyes 4 weeks postoperatively and in 10/12 eyes 6 weeks postoperatively.
Use of polyurethane film with and without SRD could delay adjustment in most eyes for up to 6 weeks postoperatively. Polyurethane is helpful for delaying adjustment in rabbit eyes until 6 weeks postoperatively without the need for frequent topical instillation of steroids.
British Journal of Ophthalmology 12/2004; 88(11):1450-4. · 2.90 Impact Factor
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ABSTRACT: AIMS/PURPOSE: To evaluate the efficacy of occlusion therapy initiated after 9 years of age.
A total of 16 amblyopes of 9 years or older (range, 9.0-14.5 years; mean, 10.5 years) with a difference in visual acuity of over two lines between the eyes alter 4 weeks of first full-time spectacle wear were included. None of the children had undergone a previous ocular examination, had ever worn spectacles, received occlusion therapy, or had strabismus surgery. Initial worst visual acuity after 4 weeks of full-time spectacle wear was 20/100 in three patients, between 20/80 and 20/40 in 11 patients, and 20/30 in two patients. Full-time occlusion was performed in 14 patients and part-time occlusion in two patients.
The final visual acuity of 15 out of 16 patients (94%) improved at least two lines. The final visual acuities ranged from 20/30 to 20/20 in 14 patients, 20/40 in one patient, and 20/50 in one remaining patient who began amblyopia therapy at 14.5 years of age, with the poorest compliance among the patients.
Occlusion therapy for anisometropic and strabismic amblyopia can be successful even if initiated after the age of 9 years.
Eye 07/2004; 18(6):571-4. · 1.85 Impact Factor
