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Kim HJ, Kim HJ, Choi JY, Yang HK, Hwang JM, Kim JS. Etiological distribution of isolated oculomotor nerve palsy: analysis of 633 patients and literature review. Eur J Neurol 2024; 31:e16261. [PMID: 38411317 DOI: 10.1111/ene.16261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND PURPOSE The etiological distribution of oculomotor nerve palsy has varied amongst the studies. This study aimed to define the clinical features and underlying etiologies of isolated oculomotor nerve palsy by recruiting patients from all departments in a referral-based university hospital. METHODS The medical records of 672 patients who had a confirmed diagnosis of isolated oculomotor nerve palsy at all departments of Seoul National University Bundang Hospital, Seongnam, South Korea, from 2003 to 2020 were reviewed. A proportion of the etiology of isolated oculomotor nerve palsy was also compared with that of patients pooled from the previous studies that were searched on PubMed in May 2022. RESULTS The most common etiology was microvascular (n = 168, 26.5%), followed by vascular anomalies (n = 110, 17.4%), neoplastic (n = 86, 13.6%), inflammatory (n = 79, 12.5%), idiopathic (n = 60, 9.5%) and traumatic (n = 53, 8.4%). Neurologists were mainly involved in the management of microvascular and inflammatory oculomotor nerve palsies whilst ophthalmologists mainly participated in the care of idiopathic, neoplastic and traumatic palsies. Neurosurgeons mostly took care of oculomotor nerve palsy due to vascular anomalies. CONCLUSIONS The proportion of etiologies of isolated oculomotor nerve palsy may differ according to the specialties involved in the management. The results of previous studies on the etiological distribution of isolated oculomotor nerve palsy should be interpreted with this consideration.
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Affiliation(s)
- Hyun-Jae Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hyo-Jung Kim
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Yang HK, Kim HY, Kim JH, Hwang JM. Trochlear nerve agenesis in a patient with 18q22.2q23 deletion. Neurol Sci 2024:10.1007/s10072-024-07554-0. [PMID: 38691274 DOI: 10.1007/s10072-024-07554-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-Do, Korea
| | - Hwa Young Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-Do, Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-Do, Korea.
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, 13620, Gyeonggi-Do, Korea.
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Yang HK, Park SH, Lee HJ, Kim SY, Gye HJ, Kim SY, Shin SY, Lim KH. Self-reported Findings of the Korean Intermittent Exotropia Multicenter Study Questionnaire. Korean J Ophthalmol 2024:kjo.2023.0129. [PMID: 38584440 DOI: 10.3341/kjo.2023.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/20/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose To determine subjective symptoms and medical history of patients with intermittent exotropia in a large study population. Methods The Korean Intermittent Exotropia Multicenter Study (KIEMS) is a nationwide, observational, cross-sectional, multicenter study conducted by the Korean Association for Pediatric Ophthalmology and Strabismus (KAPOS) including 5385 patients with intermittent exotropia. Subjective symptoms and medical history of patients with intermittent exotropia were extracted by a comprehensive survey based on a self-administered questionnaire according to the study protocol of the KIEMS. Results The mean age of symptom onset was 5.5 years of age. The most common symptom reported in patients with intermittent exotropia was photophobia (52.1%), followed by diplopia at near (7.3%) and distance fixation (6.2%). Preterm birth was found in 8.8%, and 4.1% had perinatal complications. A family history of strabismus was present in 14.9%, and 5.5% of patients had a family member who underwent strabismus surgery. Conclusions The KIEMS is one of the largest clinical studies on intermittent exotropia. Intermittent exotropia frequently caused photophobia and diplopia, and patients with a family history was not uncommon.
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Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Shin Hae Park
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Haeng-Jin Lee
- Department of Ophthalmology, Jeonbuk National University College of Medicine, Jeonju, Korea
| | - Sook-Young Kim
- Department of Ophthalmology, School of Medicine, Daegu Catholic University, Daegu, Korea
| | - Hyo Jung Gye
- Department of Ophthalmology, Nune eye hospital, Seoul, Korea
| | - So Young Kim
- Department of Ophthalmology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sun Young Shin
- Department of Ophthalmology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Key Hwan Lim
- Department of Ophthalmology, Ewha Womans University College of Medicine, Seoul, Korea
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Yang HK, Seong MW, Kim JY, Park SS, Hwang JM. Poor visual prognosis of Asian patients with 3460 mitochondrial DNA mutation in Leber's hereditary optic neuropathy. Can J Ophthalmol 2024:S0008-4182(24)00095-4. [PMID: 38593981 DOI: 10.1016/j.jcjo.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Among the 3 primary mutations of Leber's hereditary optic neuropathy (LHON), the incidence of LHON with a mutation at nucleotide position 3460 is the lowest in Asians. Therefore, information about the clinical manifestations of LHON mutations in Asians with the 3460 mutation is limited. OBJECTIVE To determine the clinical manifestations including visual prognosis of Asians with the LHON 3460 mutation. METHODS We performed a retrospective study of 5 Korean LHON patients with the 3460 mutation. RESULTS All patients were male, and the age of onset for visual impairment varied from 17 to 35 years, with an average of 25.4 ± 7.16 years. Among the 10 affected eyes, only 1 eye of 1 patient showed visual improvement to 20/50 at 2 years after onset. The remaining patients had a visual acuity of worse than 20/200. CONCLUSION The visual prognosis of Korean patients with the LHON 3460 mutation was generally poor. Further studies regarding Asian patients with the LHON 3460 mutation are necessary.
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Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji Yeon Kim
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Sung Sup Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea; Clavis Therapeutics, Inc, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Yang HK, Seong MW, Hwang JM. Mitochondrial DNA mutations in Korean patients with Leber's hereditary optic neuropathy. Sci Rep 2024; 14:5702. [PMID: 38459091 PMCID: PMC10923793 DOI: 10.1038/s41598-024-56215-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/04/2024] [Indexed: 03/10/2024] Open
Abstract
In order to explore the spectrum of mitochondrial DNA (mtDNA) mutations in Korean patients with Leber's hereditary optic neuropathy (LHON), we investigated the spectrum of mtDNA mutations in 145 Korean probands confirmed with the diagnosis of LHON. Total genomic DNA was isolated from the peripheral blood leukocytes of the patients with suspected LHON, and mtDNA mutations were identified by direct sequencing. Analysis of mtDNA mutations revealed seven primary LHON mutations including the nucleotide positions (nps) 11778A (101 probands, 69.2%), 14484C (31 probands, 21.2%), 3460A (5 probands, 3.4%), and G3635A, G3733A, C4171A, and G13051A mutations in one proband each. In addition, two provisional mtDNA mutations at nps T3472C, and G13259A were each found in one proband, respectively. Another provisional mtDNA mutation at np T3394C was found in two probands. In conclusion, the spectrum of mtDNA mutations in Korean patients with LHON may differ from other ethnicities, which is characterized by high prevalence of 11778A and 14484C mutations, and a low prevalence of the 3460A mutation.
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Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
| | - Moon-Woo Seong
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea.
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Moon Y, Park KA, Han J, Hwang JM, Kim SJ, Han SH, Lee BJ, Kang MC, Goh YH, Lim BC, Yang HK, Jung JH. Risk of central nervous system demyelinating attack or optic neuritis recurrence after pediatric optic neuritis in Korea. Neurol Sci 2024; 45:1173-1183. [PMID: 37853292 DOI: 10.1007/s10072-023-07125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To investigate the rate of development of symptomatic central nervous system (CNS) demyelinating attacks or recurrent optic neuritis (ON) after the first episode of ON and its risk factors for Korean pediatric patients. METHODS This multicenter retrospective cohort study included the patients under 18 years of age (n=132) diagnosed with ON without previous or simultaneous CNS demyelinating diseases. We obtained the clinical data including the results of neuro-ophthalmological examinations, magnetic resonance images (MRIs), antibody assays, and laboratory tests. We investigated the chronological course of demyelinating disease with respect to the occurrence of neurological symptoms and/or signs, and calculated the 5-year cumulative probability of CNS demyelinating disease or ON recurrence. RESULTS: During the follow-up period (63.1±46.7 months), 18 patients had experienced other CNS demyelinating attacks, and the 5-year cumulative probability was 14.0±3.6%. Involvement of the extraorbital optic nerve or optic chiasm and asymptomatic lesions on the brain or spinal MRI at initial presentation were significant predictors for CNS demyelinating attack after the first ON. The 5-year cumulative probability of CNS demyelinating attack was 44.4 ± 24.8% in the AQP4-IgG group, 26.2±11.4% in the MOG-IgG group, and 8.7±5.9% in the double-negative group (P=0.416). Thirty-two patients had experienced a recurrence of ON, and the 5-year cumulative probability was 24.6±4.0%. In the AQP4-IgG group, the 5-year cumulative probability was 83.3±15.2%, which was significantly higher than in the other groups (P<0.001). CONCLUSIONS A careful and multidisciplinary approach including brain/spinal imaging and antibody assay can help predict further demyelinating attacks in pediatric ON patients.
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Affiliation(s)
- Yeji Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jinu Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul, 03080, South Korea
| | - Sueng-Han Han
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min Chae Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Hyu Goh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul, 03080, South Korea.
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Park J, Hwang JM, Yang HK. Pembrolizumab-Associated Unilateral Optic Neuritis. J Clin Neurol 2024; 20:235-236. [PMID: 38212664 PMCID: PMC10921044 DOI: 10.3988/jcn.2023.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/29/2023] [Accepted: 10/02/2023] [Indexed: 01/13/2024] Open
Affiliation(s)
- Jihae Park
- Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Kim DH, Yang HK, Baek C, Seo J, Hwang JM. Efficacy of 3D-printed eye model to enhance retinoscopy skills. Sci Rep 2024; 14:4207. [PMID: 38378728 PMCID: PMC10879193 DOI: 10.1038/s41598-024-53321-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
We conducted a prospective study to evaluate the efficacy of simulation-based education using a three-dimensional (3D)-printed schematic eye model in improving the retinoscopy refraction skills of medical students. A schematic eye model was printed using a fused deposition modeling-based 3D printer. Twenty medical students randomized into 3D (n = 10) and control (n = 10) groups received a 1-h lecture on the principles and methods of manifest refraction and were shown how to use the retinoscope and sciascope bars. The 3D group additionally attended a tutorial on the schematic eye. Both groups performed refractive examinations on four eyes of volunteer patients, and the results were recorded as a baseline. Instructor feedback and refraction practice was provided with the 3D group or with control group. To account for subject fatigue, patients spent no more than 8 min on the examination. After a 1-h break to allow for fatigue and familiarity, refraction tests were repeated on four randomly selected eyes of patients. Students' refraction readings were compared with the autorefractor values using a spherical equivalent value and blur strength. All participants measured the time required to complete the refraction test and reported their subjective confidence in the results of each refraction test. Refractive errors before and after training did not differ between the control and 3D groups, with a significant improvement in errors observed in both groups (p = 0.005 and 0.008, respectively). The time to complete refraction before and after training did not differ between the two groups, both of which showed a significant reduction in time (p = 0.005 and 0.028, respectively). Pre- and post-training confidence scores for the accuracy of each refraction on a 10-point Likert scale were not significantly different. However, when comparing score changes between pre- and post-training, only the control group showed a significant increase in confidence (p = 0.005). Tests for the non-inferiority of refractive errors after training indicated that the 3D group was non-inferior to the control group. In conclusion, training in retinoscopy refraction skills using a 3D-printed eye model resulted in significant improvement in accuracy and speed compared to practice with real patients. Except for better confidence in the control group, schematic eye model training was not inferior to practice with real patients.
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Affiliation(s)
- Dong Hyun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Changhoon Baek
- Department of Transdisciplinary Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Jongmo Seo
- Department of Electrical and Computer Engineering, Seoul National University College of Engineering, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Yang HK, Kim JH, Hwang JM. Diplopia After Monovision Laser Refractive Surgery Associated With Trochlear Nerve Agenesis. J Neuroophthalmol 2023:00041327-990000000-00514. [PMID: 37988258 DOI: 10.1097/wno.0000000000002009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Hee Kyung Yang
- Departments of Ophthalmology (HKY, J-MH) and Radiology (JHK), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Park J, Yang HK, Ha YJ, Hwang JM. Early Identification and Treatment of Sjögren Syndrome With Bilateral Tonic Pupils: A Case Report. J Neuroophthalmol 2023:00041327-990000000-00405. [PMID: 37429040 DOI: 10.1097/wno.0000000000001937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Affiliation(s)
- Jihae Park
- Department of Ophthalmology (JP, HKY, J-MH), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; and Division of Rheumatology (Y-JH), Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Kim HJ, Kim HJ, Choi JY, Yang HK, Hwang JM, Kim JS. Etiologic Distribution of Isolated Abducens Nerve Palsy: Analysis of 807 Patients and Literature Review. Eur J Neurol 2023. [PMID: 37154347 DOI: 10.1111/ene.15828] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/08/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND PURPOSE The etiologies of abducens nerve palsy have shown a large variability among the studies. This study aimed to establish the clinical features and underlying etiologies of isolated abducens nerve palsy by recruiting patients from all departments in a referral-based university hospital. METHODS We reviewed the medical records of 807 patients with a confirmed diagnosis of isolated abducens nerve palsy at all departments of Seoul National University Bundang Hospital, Seongnam, Republic of Korea, from 2003 to 2020. We also compared the proportion of etiology with that of the patients pooled from the previous studies. RESULTS The most common etiology was microvascular (n = 296, 36.7%), followed by idiopathic (n = 143, 17.7%), neoplastic (n = 115, 14.3%), vascular anomalies (n = 82, 10.2%), inflammatory (n = 76, 9.4%), and traumatic (n = 35, 4.3%). Patients were mostly managed by ophthalmologists (n = 576, 71.4%), followed by neurologists (n = 479, 59.4%), emergency physicians (n = 278, 34.4%), neurosurgeons (n = 191, 23.7%), and others (n = 72, 8.9%). The proportion of etiology significantly differed according to the age and sex of the patients and the specialties involved in the management (p < 0.001). Compared to the pooled data from the previous reports, the current study showed a higher prevalence of microvascular cause but a lower occurrence of traumatic and neoplastic causes. CONCLUSIONS The results of previous studies on etiologic distribution of isolated abducens nerve palsy should be interpreted with consideration of the demographic features of patients recruited and the specialties involved.
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Affiliation(s)
- Hyun-Jae Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Hyo-Jung Kim
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kim HJ, Kim HJ, Choi JY, Yang HK, Hwang JM, Kim JS. Diplopia: characteristics and etiologic distribution in a referral-based university hospital. J Neurol 2023; 270:1067-1075. [PMID: 36355187 DOI: 10.1007/s00415-022-11471-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES The etiologic distribution and clinical features of diplopia may differ according to the specialties involved in the management. This study aimed to establish the clinical features and underlying etiologies of diplopia by recruiting patients from all departments. METHODS We reviewed the medical records of 4127 patients with diplopia as the chief complaint, who had been recruited from all departments at Seoul National University Bundang Hospital, Seongnam, Republic of Korea, from 2003 to 2020. RESULTS Diplopia was binocular in 3557 (94.2%) and monocular in 219 (5.8%) patients. The common causes of binocular diplopia included microvascular (n = 516, 14.5%), strokes (n = 412, 11.6%), neoplastic (n = 304, 8.5%), myasthenia gravis (n = 253, 7.1%), traumatic (n = 240, 6.7%), and decompensated phoria (n = 232, 6.5%), and comprised more than a half of the causes. Patients with binocular diplopia were usually managed by neurologists (2549/3557, 71.7%), followed by ophthalmologists (2247/3557, 63.2%), emergency physicians (1528/3557, 43.0%), neurosurgeons (361/3557, 10.1%), and others (271/3557, 7.6%). The etiologies of binocular diplopia differed markedly according to the patients' age and the specialties involved in the management (p < 0.001). CONCLUSIONS Given the differences in the etiologic distribution of diplopia according to the patients' age and the specialties involved in the management, the results of previous reports on the characteristics and etiology of diplopia, primarily performed in a single specialty department, should be interpreted with a possible selection bias.
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Affiliation(s)
- Hyun-Jae Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea.,Department of Medical Sciences, Neurology, Graduate School of Ajou University, Suwon, Republic of Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Yoon Choi
- Department of Neurology, Clinical Neuroscience Center, Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji-Soo Kim
- Department of Neurology, Clinical Neuroscience Center, Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. .,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Kim DH, Jung JH, Choi MY, Hwang JM, Kim SJ, Lee YH, Han SH, Choi DG, Choi HY, Choi DG, Kim DH, Lee DC, Lee SY, Lim HW, Lim HT, Lim KH, Ryu WY, Yang HK, Choi HY, Lim HT, Jung JH, Baek SH, Choi MY, Hwang JM, Kim SJ, Lee YH, Han SH, Park SH, Lee HJ, Kim SY, Lee SY, Gye HJ, Kim SY, Shin SY, Park J, Ryu WY, Park HS, Kim DH, Paik HJ, Choi DG, Lee JY, Yang HK, Oh SY, Lee SJ, Chung SA, Choi J, Oh SY, Kim M, Suh YW, Kang NY, Yum HR, Kim SA, Kim H, Han J, Cho YA, Kim H, Lew H, Lee DC, Rah SH, Yoo YJ, Lim KH, Ahn H, Kim US, Lee JH, Choung H, Kim SJ, Jeon H, Shin HJ, Han SY, Heo H, Park S, Park S, Kyung SE, Kim C, Park KA, Jung EH, Hong EH, Lim HW, Choi D, Choi YJ, Moon NJ, Lyu IJ, Cho SY. A cross-sectional study of ophthalmologic examination findings in 5385 Koreans presenting with intermittent exotropia. Sci Rep 2023; 13:1329. [PMID: 36693891 PMCID: PMC9873724 DOI: 10.1038/s41598-023-28015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023] Open
Abstract
The Korean Intermittent Exotropia Multicenter Study (KIEMS) was a retrospective, cross-sectional and multicenter study for the investigation of intermittent exotropia involved 65 strabismus specialists from 53 institutions in Korea. Purpose of this study was to present ophthalmologic findings of intermittent exotropia from the KIEMS. Consecutive patients with intermittent exotropia of ≥ 8 prism diopters (PD) at distance or near fixation were included. Best-corrected visual acuity, cycloplegic refraction data, angles of deviation at several cardinal positions, ocular dominance, fusion control, oblique muscle function, and binocular sensory outcomes were collected. A total of 5385 participants (2793 females; age 8.2 years) were included. Non-dominant eye was more myopic than the dominant eye (- 0.60 vs. - 0.47 diopters, P < 0.001). Mean exodeviation angles were 23.5 PD at distance and 25.0 PD at near fixation. Basic type (86.2%) was the most, followed by convergence insufficiency (9.4%) and divergence excess (4.4%) types. Alternating ocular dominance and good fusion control were more common at near than at distance fixation. Good stereopsis at 40 cm was observed in 49.3% in Titmus stereo test (≤ 60 arcsec) and in 71.0% in Randot stereo test (≤ 63 arcsec). Intermittent exotropia was mostly diagnosed in childhood and patients with the condition showed relatively good binocular functions. This study may provide objective findings of intermittent exotropia in a most reliable way, given that the study included a large study population and investigated comprehensive ophthalmology examinations.
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Affiliation(s)
- Dae Hee Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Mi Young Choi
- Department of Ophthalmology, Chungbuk National University College of Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Su Jin Kim
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan Pusan National University Hospital, Yangsan, Korea
| | - Yeon-Hee Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Sueng-Han Han
- Department of Ophthalmology, Yonsei University College of Medicine, Severance Eye Hospital, Seoul, Korea
| | - Dong Gyu Choi
- Department of Ophthalmology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, 1, Singil-Ro, Yeongdeungpo-Gu, Seoul, 07441, Republic of Korea.
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Yang HK, Che SA, Hyon JY, Han SB. Integration of Artificial Intelligence into the Approach for Diagnosis and Monitoring of Dry Eye Disease. Diagnostics (Basel) 2022; 12:3167. [PMID: 36553174 PMCID: PMC9777416 DOI: 10.3390/diagnostics12123167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Dry eye disease (DED) is one of the most common diseases worldwide that can lead to a significant impairment of quality of life. The diagnosis and treatment of the disease are often challenging because of the lack of correlation between the signs and symptoms, limited reliability of diagnostic tests, and absence of established consensus on the diagnostic criteria. The advancement of machine learning, particularly deep learning technology, has enabled the application of artificial intelligence (AI) in various anterior segment disorders, including DED. Currently, many studies have reported promising results of AI-based algorithms for the accurate diagnosis of DED and precise and reliable assessment of data obtained by imaging devices for DED. Thus, the integration of AI into clinical approaches for DED can enhance diagnostic and therapeutic performance. In this review, in addition to a brief summary of the application of AI in anterior segment diseases, we will provide an overview of studies regarding the application of AI in DED and discuss the recent advances in the integration of AI into the clinical approach for DED.
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Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Song A Che
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Sang Beom Han
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon 24289, Republic of Korea
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15
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Kim HJ, Kim HJ, Choi JY, Yang HK, Hwang JM, Kim JS. Etiologic Distribution of Isolated Trochlear Palsy: Analysis of 1,020 Patients and Literature Review. Eur J Neurol 2022; 29:3658-3665. [PMID: 36052663 DOI: 10.1111/ene.15541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/08/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Trochlear palsy is the most common cause of vertical diplopia. The etiologies of trochlear palsy have shown a large discrepancy among the studies. This study aimed to establish the clinical features and underlying etiologies of isolated trochlear palsy by recruiting the patients from all departments in a referral-based university hospital. METHODS We reviewed the medical records of 1,258 patients who had a confirmed diagnosis of isolated trochlear palsy at all departments of Seoul National University Bundang Hospital, Seongnam, South Korea, from 2003 to 2020. We also compared the proportion of etiology with that of the patients pooled from the previous studies. RESULTS The most common etiology was congenital (n = 330, 32.4%), followed by idiopathic (n = 256, 25.1%), microvascular (n = 212, 20.8%), and traumatic (n = 145, 14.2%). These four etiologies explained 92.5% of isolated trochlear palsy. Patients were mostly managed by ophthalmologists (n = 841, 82.5%), followed by neurologists (n = 380, 37.3%), emergency physicians (n = 197, 19.3%), neurosurgeons (n = 75, 7.4%), and others (n = 18, 1.8%). The etiologic distribution of isolated trochlear palsy in the current study did not differ from that of 2,664 patients pooled from the previous studies. CONCLUSIONS The proportion of etiologies of isolated trochlear palsy differs according to the age ranges of the patients and specialties involved in the management. The etiologic distribution of isolated trochlear palsy in the current study was comparable to the pooled result of previous reports.
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Affiliation(s)
- Hyun-Jae Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea.,Department of Medical Sciences, Neurology, Graduate School of Ajou University, Suwon, Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Republic of Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Yang HK, Hwang JM. Development of acquired non-accommodative esotropia in a patient without a trochlear nerve. Int J Ophthalmol 2022; 15:1030-1031. [DOI: 10.18240/ijo.2022.06.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
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Cho SD, Kim DH, Yang HK, Hwang JM. Posterior Ischemic Optic Neuropathy after Cervical Spine Surgery. J Korean Ophthalmol Soc 2021. [DOI: 10.3341/jkos.2021.62.10.1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To describe a patient with posterior ischemic optic neuropathy (PION) after cervical spine surgery who recovered after treatment.Case summary: A 51-year-old woman presented with eye pain and decreased visual acuity in the left eye, which had begun 8 hours after cervical spine surgery in the prone position. Her best-corrected visual acuity (BCVA) was 20/20 in the right eye and hand motion in the left eye; a relative afferent pupillary defect was present in the left eye. Ductions and versions were normal with pain in the left eye. The results of slit lamp examination, fundoscopic examination, fluorescein angiography, and optical coherence tomography were unremarkable in both eyes. Brain and orbital magnetic resonance imaging showed no abnormal findings in the visual pathway, such as brain infarction or intracranial artery stenosis. The patient was diagnosed with PION in the left eye. Because postoperative anemia had developed with a rapid decrease in hemoglobin from 14.7 g/dL to 9.9 g/dL, red blood cell (RBC) transfusion was performed together with intravenous high-dose steroid therapy and subcutaneous epoetin alfa injection. After 3 weeks, the patient’s BCVA improved to 20/22 in the left eye.Conclusions: Unilateral PION developed after cervical spine surgery in the prone position. Visual improvement was observed after RBC transfusion, intravenous high-steroid therapy, and subcutaneous epoetin alfa injection.
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Kim DH, Yang HK, Hwang JM. Long term surgical outcomes of unilateral recession-resection versus bilateral lateral rectus recession in basic-type intermittent exotropia in children. Sci Rep 2021; 11:19383. [PMID: 34588536 PMCID: PMC8481325 DOI: 10.1038/s41598-021-98801-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
The long-term results of surgical treatment of intermittent exotropia (X(T)) according to the type of surgery are controversial. We conducted a retrospective cohort study to compare the long-term results between unilateral recession-resection (RR) and bilateral lateral rectus recession (BLR) with an average follow-up of 9.5 years in children with basic-type X(T). Patients with basic-type X(T), who underwent RR (RR group) or BLR (BLR group) and were followed-up for more than 5 years postoperatively, were analyzed. Of the 560 patients, 363 patients received BLR and 197 patients underwent RR. There was no significant difference in the success rates between the two groups until postoperative 3 years. At an average of 9.5 ± 2.6 years after surgery, the success rate of the RR group was significantly higher than that of the BLR group starting from the fourth post-operative year until the last follow-up examination (64.5% vs 43.3%, P < 0.001). By multivariate analysis, preoperative hyperopia of more than + 2.00 diopters, younger age of onset, younger age at surgery, larger exodeviation at near than at distance of > 5 prism diopters, and the type of surgery (BLR) were risk factors of recurrence. In conclusion, RR was more successful than BLR with a lower recurrence rate in the long-term follow-up of patients with basic-type X(T).
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Affiliation(s)
- Dong Hyun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumiro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumiro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumiro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
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Kim JA, Lee EJ, Kim TW, Yang HK, Hwang JM. Comparison of Optic Nerve Head Microvasculature Between Normal-Tension Glaucoma and Nonarteritic Anterior Ischemic Optic Neuropathy. Invest Ophthalmol Vis Sci 2021; 62:15. [PMID: 34398197 PMCID: PMC8374994 DOI: 10.1167/iovs.62.10.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare the microvasculature of the optic nerve head (ONH) and peripapillary tissues in eyes with normal-tension glaucoma (NTG) and nonarteritic anterior ischemic optic neuropathy (NAION) using optical coherence tomography angiography (OCTA). Methods Thirty-eight eyes with treatment-naïve NTG, 38 eyes with NAION matched for retinal nerve fiber layer (RNFL) thickness in each superior and inferior quadrant, and 38 healthy eyes matched by age were included. ONH and peripapillary retinal microvasculature was evaluated in en face images obtained using OCTA. Vessel density (VD) was calculated as the percent area occupied by vessels in the measured region in each layer segmented into the prelaminar tissue (PLT), lamina cribrosa (LC), and peripapillary retina (PR). Results VDs in the PLT and LC were lower in NTG eyes than in both NAION and healthy eyes (P ≤ 0.008), and did not differ between the NAION and healthy eyes. VDs in the PR did not differ between the NTG and NAION eyes. In intersectoral comparisons, VDs in the PLT (P = 0.030) and LC (P = 0.028) were lower in the affected than in the unaffected sector of eyes with NTG, but the differences did not occur in eyes with NAION. VD in the PR was lower in the affected than in the unaffected sector in both NTG and NAION eyes (both P < 0.001). Conclusions Despite similar degrees of RNFL loss and VD decreases in the PR, VDs in the ONH differed between eyes with NTG and NAION, indicating different mechanisms of vascular impairment and ONH damage in each condition.
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Affiliation(s)
- Ji-Ah Kim
- Department of Ophthalmology, Ewha Womans University College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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20
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Roh YJ, Kim DH, Yang HK, Hwang JM. Optic Perineuritis as a Presenting Sign of Sarcoidosis. J Korean Ophthalmol Soc 2021. [DOI: 10.3341/jkos.2021.62.7.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To report a rare case of optic perineuritis as the presenting sign of sarcoidosis. Case summary: A 57-year-old man presented with decreased visual acuity and pain with extraocular movement in his left eye starting 2 weeks earlier. He had a history of asymptomatic optic perineuritis in that eye 18 months previously, which had improved after 1 month on oral prednisolone. His best corrected visual acuity had decreased to 20/50 and he also had relative afferent pupillary defect and color vision defects in the left eye. Slit lamp examination results were normal. There were no inflammatory reactions in the anterior chamber or vitreous. Fundoscopy showed optic disc edema. Orbital magnetic resonance imaging showed diffuse enhancement surrounding the left optic nerve. The serum levels of eosinophil cationic protein and angiotensin- converting enzyme were markedly increased. A chest radiograph showed bilateral hilar lymph node enlargement. A biopsy via endobronchial ultrasound-guided transbronchial needle aspiration revealed multifocal non-caseating granulomas. Acid fast bacilli stain showed no evidence of tuberculosis. Based on these findings, he was diagnosed with sarcoidosis. After treatment with high-dose intravenous methylprednisolone and subsequent tapering with oral prednisolone for 6 months, the visual acuity improved. Conclusions: Optic perineuritis can be the initial sign of sarcoidosis. Therefore, sarcoidosis should be considered in the differential diagnosis of optic perineuritis.
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21
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Kim DH, Baek SH, Choi HY, Choi DG, Lee DC, Lee SY, Lim HW, Lim HT, Ryu WY, Yang HK, Lim KH. An Overview of the Korean Intermittent Exotropia Multicenter Study by the Korean Association for Pediatric Ophthalmology and Strabismus. ACTA ACUST UNITED AC 2021; 35:355-359. [PMID: 34237205 PMCID: PMC8521330 DOI: 10.3341/kjo.2021.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022]
Abstract
The Korean Intermittent Exotropia Multicenter Study (KIEMS), which was initiated by the Korean Association of Pediatric Ophthalmology and Strabismus, is a collaborative multicenter study on intermittent exotropia in Korea. The KIEMS was designed to provide comprehensive information, including subjective and objective findings of intermittent exotropia in a large study population. A total of 65 strabismus specialists in 53 institutions contributed to this study, which, to date, is one of the largest clinical studies on intermittent exotropia. In this article, we provide a detailed methodology of the KIEMS to help future investigations that may use the KIEMS data.
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Affiliation(s)
- Dae Hee Kim
- Strabismus & Pediatric Ophthalmology Center, Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea
| | - Seung-Hee Baek
- Strabismus & Pediatric Ophthalmology Center, Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea
| | - Hee-Young Choi
- Department of Ophthalmology, Pusan National University, School of Medicine, Busan, Korea
| | - Dong Gyu Choi
- Department of Ophthalmology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Dong Cheol Lee
- Department of Ophthalmology, Keimyung University, School of Medicine, Daegu, Korea
| | - Se-Youp Lee
- Department of Ophthalmology, Keimyung University, School of Medicine, Daegu, Korea
| | - Han Woong Lim
- Department of Ophthalmology, Hanyang University School of Medicine, Seoul, Korea
| | - Hyun Taek Lim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Won Yeol Ryu
- Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Key Hwan Lim
- Department of Ophthalmology, Ewha Womans University College of Medicine, Seoul, Korea
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22
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Yoo YJ, Hwang JM, Yang HK. Dilute pilocarpine test for diagnosis of Adie's tonic pupil. Sci Rep 2021; 11:10089. [PMID: 33980910 PMCID: PMC8115311 DOI: 10.1038/s41598-021-89148-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/12/2021] [Indexed: 11/08/2022] Open
Abstract
We have compared the diagnostic ability of different concentrations of 0.125% and 0.0625% dilute pilocarpine for detecting denervation supersensitivity in unilateral Adie's tonic pupil. This retrospective, observational, case-control study involved 117 subjects, consisting of 56 patients with unilateral Adie's tonic pupil and 61 controls with other causes of unilateral dilated pupils. Subjects underwent the dilute pilocarpine test with one of the two concentrations, 0.125% or 0.0625%. Pupillary light reflex was recorded with a dynamic pupillometer at baseline and at 30-40 min after instilling one of the two concentrations of dilute pilocarpine. Diagnostic accuracy of two different concentrations of the dilute pilocarpine test, 0.125% group versus 0.0625% group, were compared by area under the receiver operating characteristic curve (AUC). Diagnostic ability of the dilute pilocarpine test for detecting denervation supersensitivity in unilateral Adie's tonic pupil was significantly better in the 0.0625% group than in the 0.125% group (AUC = 0.954 vs. 0.840, respectively, P = 0.047). In the 0.0625% group, the change in maximal pupil diameter of ≥ 0.5 mm after topical pilocarpine instillation showed 100% sensitivity and 82.8% specificity for detecting Adie's tonic pupil. This study confirmed that pupillary constriction with 0.0625% pilocarpine is better than 0.125% pilocarpine for detecting denervation supersensitivity in Adie's tonic pupil. Digital pupillometry is a reliable method for assessing denervation supersensitivity in Adie's tonic pupil.
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Affiliation(s)
- Yung-Ju Yoo
- Department of Ophthalmology, Kangwon National University Graduate School of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Korea.
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23
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Kwon E, Yoon BA, Kim HJ, Choi JY, Yang HK, Kim JS. Acute Acquired Concomitant Esotropia in Anti-GQ1b-Antibody Syndrome. J Clin Neurol 2021; 17:322-324. [PMID: 33835756 PMCID: PMC8053551 DOI: 10.3988/jcn.2021.17.2.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Eunjin Kwon
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
| | - Byeol A Yoon
- Department of Neurology, Peripheral Neuropathy Research Center, Dong-A University College of Medicine, Busan, Korea
| | - Hyo Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Soo Kim
- Dizziness Center, Clinical Neuroscience Center, Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
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Kim JY, Yang HK, Kim N, Kim MJ, Cho SI, Seong M, Park SS, Hwang J. Strabismus in chronic progressive external ophthalmoplegia. Acta Ophthalmol 2021; 99:e274-e280. [PMID: 33191655 DOI: 10.1111/aos.14558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 07/02/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To elucidate the patterns of strabismus and ophthalmoplegia associated with chronic progressive external ophthalmoplegia (CPEO) confirmed by mitochondrial DNA (mtDNA) deletions in Asians. METHODS A total of 10 patients confirmed to have mtDNA deletion associated with CPEO were included. Long-range PCR encompassing the entire mtDNA was carried out. In the cases with mtDNA deletion, the exact deletion ranges of mtDNA were identified by sequencing. A full ophthalmologic examination including prism and alternate cover test in the primary position, evaluation of ductions and versions, and binocularity was performed in 10 patients with confirmed mtDNA deletions associated with CPEO. RESULTS All of the patients showed ophthalmoplegia as well as ptosis, even after eyelid surgeries. Ophthalmoplegia was symmetric between both eyes in nine patients (90%) while one patient (10%) showed asymmetric ophthalmoplegia with esotropia and left hypotropia. Among the nine patients with symmetric involvement, four patients (44%) showed exotropia, three (33%) had exotropia with vertical deviation, and the remaining two patients (22%) showed orthotropia. Five out of 10 patients (50%) complained of diplopia associated with strabismus, four of whom (80%) had vertical deviation. Three out of five patients (60%) without diplopia showed exotropia of 20 prism diopters (PD) to 50 PD. CONCLUSIONS Exotropia with/without vertical deviation is the most common form of strabismus in Asian patients with CPEO and only one of them showed a small angle of esotropia. Ophthalmoplegia could be asymmetric in 10% of CPEO patients.
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Affiliation(s)
- Ji Yeon Kim
- Biomedical Research Institute Seoul National University Hospital Seoul Korea
| | - Hee Kyung Yang
- Department of Ophthalmology Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam Korea
| | - Namju Kim
- Department of Ophthalmology Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam Korea
| | - Man Jin Kim
- Department of Laboratory Medicine Seoul National University HospitalSeoul National University College of Medicine Seoul Korea
| | - Sung Im Cho
- Department of Laboratory Medicine Seoul National University HospitalSeoul National University College of Medicine Seoul Korea
| | - Moon‐Woo Seong
- Biomedical Research Institute Seoul National University Hospital Seoul Korea
- Department of Laboratory Medicine Seoul National University HospitalSeoul National University College of Medicine Seoul Korea
| | - Sung Sup Park
- Biomedical Research Institute Seoul National University Hospital Seoul Korea
- Department of Laboratory Medicine Seoul National University HospitalSeoul National University College of Medicine Seoul Korea
| | - Jeong‐Min Hwang
- Department of Ophthalmology Seoul National University College of MedicineSeoul National University Bundang Hospital Seongnam Korea
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Na HM, Yang HK, Hwang JM. Visual Field Ratio According to Distance in the Near Tangent Screen Test. J Korean Ophthalmol Soc 2021. [DOI: 10.3341/jkos.2021.62.2.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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26
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Jung EH, Yang HK, Hwang JM, Seo JM, Kim KG, Khwarg SI, Yu YS, Kim SJ. Change in the eye position under general anesthesia in children with intermittent exotropia. J AAPOS 2021; 25:5.e1-5.e7. [PMID: 33662588 DOI: 10.1016/j.jaapos.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/17/2020] [Accepted: 09/06/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the eye position in subjects with intermittent exotropia and normal subjects under general anesthesia (GA) using the strabismus photo analyzer. METHODS This retrospective case-control study included 78 subjects with intermittent exotropia and 25 normal control subjects who underwent epiblepharon surgery. Eye position under GA was assessed using the strabismus photo analyzer, based on eye models generated from corneal lights and limbus in pre- and post-anesthesia images. Eye positions under GA in the control and intermittent exotropia groups were compared. Preoperative angle of deviation was also compared with amount of change in eye position under GA in the intermittent exotropia group. RESULTS Eye position under GA was more divergent in subjects with intermittent exotropia than in controls (P = 0.008). The amount of change in eye position under GA was correlated with the preoperative angle of deviation (r2 = 0.47; P < 0.001). In small preoperative exodeviations, the change in eye position was primarily more divergent, whereas in large exodeviations, a convergent tendency-less exotropic compared with the preoperative angle of exodeviation-was observed. CONCLUSIONS In subjects with small preoperative exodeviations, there was a tendency for eye position to become more divergent after GA; in those with large exodeviations, there was less exotropia after GA.
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Affiliation(s)
- Eun Hye Jung
- Department of Ophthalmology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea; Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Mo Seo
- Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - Kwang Gi Kim
- Department of Biomedical Engineering, Gil Medical Center, Gachon University, Incheon, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Young Suk Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea.
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Kim JA, Lee EJ, Kim TW, Kim H, Girard MJA, Mari JM, Yang HK, Hwang JM. Differentiation of Nonarteritic Anterior Ischemic Optic Neuropathy from Normal Tension Glaucoma by Comparison of the Lamina Cribrosa. Invest Ophthalmol Vis Sci 2021; 61:21. [PMID: 32668001 PMCID: PMC7425687 DOI: 10.1167/iovs.61.8.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose To compare lamina cribrosa (LC) morphology between eyes with nonarteritic anterior ischemic optic neuropathy (NAION) and eyes with normal tension glaucoma (NTG) in the Korean population. Methods This retrospective study included 48 eyes with NAION, 48 eyes with NTG, and 48 healthy control eyes matched by age, intraocular pressure, axial length, and optic disc area. Eyes with NAION and NTG were also matched by retinal nerve fiber layer (RNFL) thickness in the affected sector. Optic nerve heads were scanned using enhanced depth imaging spectral-domain optical coherence tomography. LC depth (LCD) and the LC curvature index (LCCI) were measured at seven locations spaced equidistantly across the vertical optic disc diameter. LCD and the LCCI were compared in the three groups. Results RNFL thicknesses of the matched affected sectors did not differ between the NAION and NTG groups (P = 0.347). LCD and the LCCI were significantly larger in the NTG group than in the NAION and healthy control groups at all seven planes (P < 0.001 each), but were comparable in the NAION and healthy control groups. The LCCI was larger in the affected than in the unaffected sector of NTG eyes (P = 0.010) but did not differ in NAION eyes (P = 1.000). LCD did not differ between affected and unaffected sectors in either NAION (P = 0.600) or NTG (P = 0.098) eyes. Conclusions LC morphology differed in eyes with NAION and NTG, despite a similar degree of RNFL damage. Evaluation of LC morphology may help to understand the distinctive pathophysiology of NAION and to differentiate NAION from NTG eyes.
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Abstract
We evaluated changes in the pupillary light reflex (PLR) of ethambutol (EMB)-induced optic neuropathy and analyzed the correlations between PLR parameters and other structural changes in EMB-induced optic neuropathy. This retrospective, observational, case–control study involved thirty-two eyes of 17 patients with EMB-induced optic neuropathy (EON group), sixty eyes of 60 patients without EMB-induced optic neuropathy (non-EON group) while taking ethambutol, and forty-five eyes of 45 normal controls. PLR was measured by digital pupillometry. The clinical characteristics, optical coherence tomography measurements and PLR parameters including pupil diameter, constriction latency, constriction ratio/velocity, and dilation velocity were noted. The differences in PLR measurements were compared among the three groups. Correlations between PLR parameters and other structural parameters in EMB-induced optic neuropathy were evaluated. The pupillary constriction ratio, constriction and dilation velocities were significantly reduced in the EON group compared to the non-EON group and controls (all P < 0.05). In EMB-induced optic neuropathy, average outer macular ganglion cell layer (mGCL) thickness showed a significant correlation with the pupillary constriction ratio (ß = 4.14, P = 0.003) and maximal constriction velocity (ß = 1.08, P < 0.001). This study confirmed that pupillary constriction and dilation velocities were significantly decreased in patients with EMB-induced optic neuropathy, compared to normal controls. Digital pupillometry may be a useful tool in the evaluation of EMB-induced optic neuropathy.
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Affiliation(s)
- Yung-Ju Yoo
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, 173 Beon-gil, Bundang-gu, Gumi-ro, Seongnam, Gyeonggi-do, 13620, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, 173 Beon-gil, Bundang-gu, Gumi-ro, Seongnam, Gyeonggi-do, 13620, Korea.
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Abstract
Purpose To investigate the efficacy of botulinum toxin injection without electromyographic guidance for the treatment of consecutive esotropia. Methods A retrospective study was performed on 49 subjects with consecutive esotropia who received botulinum toxin injection in the medial rectus muscles without the use of electromyographic guidance. Treatment was considered successful if the final ocular alignment was orthotropic or esodeviation was ≤10 prism diopters (PD) during distant fixation. Results The mean age was 15.2 ± 8.3 years. The mean esodeviation before injection was 21.8 ± 9.1 PD at distance and 21.3 ± 8.3 PD at near. The mean number of injections per patient was 1.3 ± 0.7, and 46 patients (93.9%) received two or fewer injections. At 6 months after the final injection, the mean angle of esodeviation was 7.3 ± 6.0 PD at distance and 7.5 ± 6.6 PD at near (all p<0.001), and 69.4% showed successful alignment. By multivariate analysis, an initial postoperative esodeviation of ≤18 PD at one month after exotropia surgery was considered to be a predictive factor for successful botulinum toxin injection (P = 0.007). Vertical deviation and/or ptosis occurred in 4 patients (8.2%) at two weeks after injection, which all resolved within three months. There was no recurrence of exotropia up to the final follow-up examination. Conclusion Botulinum toxin injection without electromyographic guidance is safe and effective in the treatment of consecutive esotropia without causing recurrent exotropia. Successful botulinum toxin injection is likely in patients with an initial postoperative esodeviation of 18PD or less at one month after exotropia surgery.
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Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Hyun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
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Kim MS, Lee KM, Hwang JM, Yang HK, Woo SJ. Reply to Comment on: Morphologic Features of Buried Optic Disc Drusen on En Face Optical Coherence Tomography and Optical Coherence Tomography Angiography. Am J Ophthalmol 2020; 219:370-371. [PMID: 32646543 DOI: 10.1016/j.ajo.2020.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 11/30/2022]
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Kim MS, Hwang JM, Yang HK, Woo SJ, Lee KM. Reply to Comment on: Morphologic Features of Buried Optic Disc Drusen on En Face Optical Coherence Tomography and Optical Coherence Tomography Angiography. Am J Ophthalmol 2020; 219:368-369. [PMID: 32473737 DOI: 10.1016/j.ajo.2020.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
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Yoo YJ, Han SB, Yang HK, Hwang JM. Ocular coloboma combined with cleft lip and palate: a case report. BMC Ophthalmol 2020; 20:418. [PMID: 33076860 PMCID: PMC7574458 DOI: 10.1186/s12886-020-01696-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ocular coloboma is an excavation of ocular structures that occurs due to abnormal fusion of the embryonic optic fissure. Further, cleft lip/palate (CL/P), a congenital midline abnormality, is caused by a defect in the fusion of the frontonasal, maxillary, and mandibular prominences. No study has reported the association between these two phenotypes in the absence of other systemic abnormalities. We present a case of ocular coloboma along with CL/P and without other neurological abnormalities. Case presentation A 5-year-old Asian boy presented with decreased visual acuity in his right eye. Physical examination revealed no abnormal findings except CL/P, which was surgically corrected at the age of 9 months. Best-corrected visual acuity was 20/60 in the right eye and 20/25 in the left eye. Anterior segment examination revealed iris coloboma in the inferior quadrant of his right eye as well as a large inferonasal optic disc and chorioretinal coloboma in the same eye. He was prescribed glasses based on his cycloplegic refractive errors and part-time occlusion of the left eye was recommended. After 3 months, best-corrected visual acuity improved to 20/30 in the right eye. Conclusion The association of ocular coloboma should be kept in mind when encountering a patient with CL/P without other neurological or systemic abnormalities.
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Affiliation(s)
- Yung Ju Yoo
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University School of Medicine, 156 Baengnyeong-ro, Chuncheon, 24289, South Korea
| | - Sang Beom Han
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University School of Medicine, 156 Baengnyeong-ro, Chuncheon, 24289, South Korea.
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Yoo YJ, Yang HK, Choi JY, Kim JS, Hwang JM. Neuro-ophthalmologic Findings in Visual Snow Syndrome. J Clin Neurol 2020; 16:646-652. [PMID: 33029971 PMCID: PMC7541978 DOI: 10.3988/jcn.2020.16.4.646] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 12/16/2022] Open
Abstract
Background and Purpose The findings of ophthalmic examinations have not been systematically investigated in visual snow syndrome. This study reviewed the abnormal neuro-ophthalmologic findings in a patient cohort with symptoms of visual snow syndrome. Methods We retrospectively reviewed 28 patients who were referred for symptoms of visual snow to a tertiary referral hospital from November 2016 to October 2019. We defined the findings of best corrected visual acuity (BCVA), visual field testing, pupillary light reflex, contrast sensitivity, full-field and multifocal electroretinography, and optical coherence tomography. Results Twenty patients (71%) were finally diagnosed as visual snow syndrome. Their additional visual symptoms included illusionary palinopsia (61%), enhanced entoptic phenomenon (65%), disturbance of night vision (44%), and photophobia (65%). A history of migraine was identified in ten patients (50%). The mean BCVA was less than 0.1 logarithm of the minimum angle of resolution, and electrophysiology showed normal retinal function in all patients. Contrast sensitivity was decreased in two of the seven patients tested. Medical treatment was applied to five patients which all turned out to be ineffective. Among the eight patients who were excluded, one was diagnosed with rod-cone dystrophy and another with idiopathic intracranial hypertension. Conclusions Neuro-ophthalmologic findings are mostly normal in patients with visual snow syndrome. Retinal or neurological diseases must be excluded as possible causes of visual snow.
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Affiliation(s)
- Yung Ju Yoo
- Department of Ophthalmology, Kangwon National University Graduate School of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Kim H, Yang HK, Seo JM, Lee S, Hwang JM. Effect of Ultra-high-definition Television on Ocular Surface and Fatigue. Korean J Ophthalmol 2020; 34:367-374. [PMID: 33099558 PMCID: PMC7597618 DOI: 10.3341/kjo.2020.0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the effects of watching ultra-high-definition television (UHD TV) on subjective ocular fatigue and objective ocular surface indices. METHODS A total of 76 volunteers were recruited for this study. Subjects watched UHD TV for 10 minutes at a viewing distance of 110 cm. Best-corrected visual acuity, refractive errors, tear break-up time, corneal staining grading, conjunctival redness grading by slit-lamp examination, tear meniscus measurement by anterior segment optical coherence tomography, and ocular symptom scores were obtained before and immediately after watching UHD TV. Subgroup analyses were conducted according to participant age (old age group >50 years vs. young age group ≤50 years) and dry-eye syndrome (presence vs. absence). The relationship between subjective and objective indices was evaluated. RESULTS The mean age of subjects was 39.6 ± 12.4 years. Watching UHD TV induced a decrease in tear break-up time in the non-dry-eye group (p < 0.001) but not in the dry-eye group (p = 0.726). Corneal staining grades increased in all subgroups, and the changes were particularly larger in the older group (p = 0.038). The increase in ocular symptom scores was larger in the dry-eye group (p = 0.08) and in the older group (p = 0.016). The decrease in tear break-up time and ocular symptom scores after watching UHD TV was significantly correlated with tear break-up time. CONCLUSIONS Tear break-up time significantly decreased in non-dry-eye subjects after watching UHD TV. Subjective ocular discomfort increased significantly in subjects over the age of 50 and in participants with dry-eye syndrome.
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Affiliation(s)
- Hyuna Kim
- Department of Ophthalmology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong-Mo Seo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Electrical and Computer Engineering, Seoul National University, Seoul, Korea
| | - Sanghoon Lee
- School of Electrical Engineering, Yonsei University, Seoul, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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35
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Lee SH, Kim DH, Yang HK. Acquired Brown Syndrome Secondary to Trochleitis. J Korean Ophthalmol Soc 2020. [DOI: 10.3341/jkos.2020.61.9.1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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36
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Yang HK, Kim JH, Hwang JM. Teaching NeuroImages: Pupil-sparing oculomotor nerve palsy with posterior communicating artery aneurysm. Neurology 2020; 95:e1443-e1444. [PMID: 32641523 DOI: 10.1212/wnl.0000000000010152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Hee Kyung Yang
- From the Departments of Ophthalmology (H.K.Y., J.-M.H.) and Radiology and Neurology (J.H.K.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
| | - Jae Hyoung Kim
- From the Departments of Ophthalmology (H.K.Y., J.-M.H.) and Radiology and Neurology (J.H.K.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea
| | - Jeong-Min Hwang
- From the Departments of Ophthalmology (H.K.Y., J.-M.H.) and Radiology and Neurology (J.H.K.), Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea.
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Biousse V, Newman NJ, Najjar RP, Vasseneix C, Xu X, Ting DS, Milea LB, Hwang JM, Kim DH, Yang HK, Hamann S, Chen JJ, Liu Y, Wong TY, Milea D. Optic Disc Classification by Deep Learning versus Expert Neuro-Ophthalmologists. Ann Neurol 2020; 88:785-795. [PMID: 32621348 DOI: 10.1002/ana.25839] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare the diagnostic performance of an artificial intelligence deep learning system with that of expert neuro-ophthalmologists in classifying optic disc appearance. METHODS The deep learning system was previously trained and validated on 14,341 ocular fundus photographs from 19 international centers. The performance of the system was evaluated on 800 new fundus photographs (400 normal optic discs, 201 papilledema [disc edema from elevated intracranial pressure], 199 other optic disc abnormalities) and compared with that of 2 expert neuro-ophthalmologists who independently reviewed the same randomly presented images without clinical information. Area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were calculated. RESULTS The system correctly classified 678 of 800 (84.7%) photographs, compared with 675 of 800 (84.4%) for Expert 1 and 641 of 800 (80.1%) for Expert 2. The system yielded areas under the receiver operating characteristic curve of 0.97 (95% confidence interval [CI] = 0.96-0.98), 0.96 (95% CI = 0.94-0.97), and 0.89 (95% CI = 0.87-0.92) for the detection of normal discs, papilledema, and other disc abnormalities, respectively. The accuracy, sensitivity, and specificity of the system's classification of optic discs were similar to or better than the 2 experts. Intergrader agreement at the eye level was 0.71 (95% CI = 0.67-0.76) between Expert 1 and Expert 2, 0.72 (95% CI = 0.68-0.76) between the system and Expert 1, and 0.65 (95% CI = 0.61-0.70) between the system and Expert 2. INTERPRETATION The performance of this deep learning system at classifying optic disc abnormalities was at least as good as 2 expert neuro-ophthalmologists. Future prospective studies are needed to validate this system as a diagnostic aid in relevant clinical settings. ANN NEUROL 2020;88:785-795.
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Affiliation(s)
- Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Raymond P Najjar
- Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
| | | | - Xinxing Xu
- Institute of High-Performance Computing, Agency for Science, Technology, and Research, Singapore
| | - Daniel S Ting
- Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,Singapore National Eye Center, Singapore
| | - Léonard B Milea
- University of California, Berkeley, Berkeley, California, USA
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Dong Hyun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - John J Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong Liu
- Institute of High-Performance Computing, Agency for Science, Technology, and Research, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,Singapore National Eye Center, Singapore
| | - Dan Milea
- Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore.,Singapore National Eye Center, Singapore
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Yang HK, Kim YJ, Sung JY, Kim DH, Kim KG, Hwang JM. Efficacy for Differentiating Nonglaucomatous Versus Glaucomatous Optic Neuropathy Using Deep Learning Systems. Am J Ophthalmol 2020; 216:140-146. [PMID: 32247778 DOI: 10.1016/j.ajo.2020.03.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE We sought to assess the performance of deep learning approaches for differentiating nonglaucomatous optic neuropathy with disc pallor (NGON) vs glaucomatous optic neuropathy (GON) on color fundus photographs by the use of image recognition. DESIGN Development of an Artificial Intelligence Classification algorithm. METHODS This single-institution analysis included 3815 fundus images from the picture archiving and communication system of Seoul National University Bundang Hospital consisting of 2883 normal optic disc images, 446 NGON images, and 486 GON images. The presence of NGON and GON was interpreted by 2 expert neuro-ophthalmologists and had corroborated evidence on visual field testing and optical coherence tomography. Images were preprocessed in size and color enhancement before input. We applied the convolutional neural network (CNN) of ResNet-50 architecture. The area under the precision-recall curve (average precision) was evaluated for the efficacy of deep learning algorithms to assess the performance of classifying NGON and GON. RESULTS The diagnostic accuracy of the ResNet-50 model to detect GON among NGON images showed a sensitivity of 93.4% and specificity of 81.8%. The area under the precision-recall curve for differentiating NGON vs GON showed an average precision value of 0.874. False positive cases were found with extensive areas of peripapillary atrophy and tilted optic discs. CONCLUSION Artificial intelligence-based deep learning algorithms for detecting optic disc diseases showed excellent performance in differentiating NGON and GON on color fundus photographs, necessitating further research for clinical application.
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Yang HK, Gong HS, Hwang JM. Congenital superior oblique palsy in a patient with Holt-Oram syndrome. Neurol Sci 2020; 42:373-375. [PMID: 32710205 DOI: 10.1007/s10072-020-04530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/21/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Choi JH, Kim JM, Yang HK, Lee HJ, Shin CM, Jeong SJ, Kim WS, Han JW, Yoon IY, Song YS, Bae YJ. Clinical Perspectives of Parkinson's Disease for Ophthalmologists, Otorhinolaryngologists, Cardiologists, Dentists, Gastroenterologists, Urologists, Physiatrists, and Psychiatrists. J Korean Med Sci 2020; 35:e230. [PMID: 32686370 PMCID: PMC7371452 DOI: 10.3346/jkms.2020.35.e230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/27/2020] [Indexed: 12/29/2022] Open
Abstract
Parkinson's disease (PD) is a multisystemic disorder characterized by various non-motor symptoms (NMS) in addition to motor dysfunction. NMS include sleep, ocular, olfactory, throat, cardiovascular, gastrointestinal, genitourinary, or musculoskeletal disorders. A range of NMS, particularly hyposmia, sleep disturbances, constipation, and depression, can even appear prior to the motor symptoms of PD. Because NMS can affect multiple organs and result in major disabilities, the recognition and multidisciplinary and collaborative management of NMS by physicians is essential for patients with PD. Therefore, the aim of this review article is to provide an overview of the organs that are affected by NMS in PD together with a brief review of pathophysiology and treatment options.
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Affiliation(s)
- Ji Hyun Choi
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyo Jung Lee
- Department of Dentistry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Won Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - In Young Yoon
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoo Sung Song
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Kim DH, Yang HK, Hwang JM. Long-term surgical outcomes of preoperative prism adaptation in patients with partially accommodative esotropia. Eye (Lond) 2020; 35:1165-1170. [PMID: 32678351 DOI: 10.1038/s41433-020-1086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND To determine the long-term surgical outcomes of preoperative prism adaptation test (PAT) in patients with partially accommodative esotropia. METHODS PAT was performed for the remaining esotropia after full correction of hyperopia. Prism adaptation (PA) responders were defined as patients with stable esodeviation between 0 and 8 prism diopters (PD) while developing sensory fusion throughout the prism adaptation period. Surgical success was defined as a deviation within 8 PD of both the far and near deviation angles at the last follow-up examination. RESULTS Of the 102 patients, 43 (42.2%) were PA responders, and 59 were PA non-responders (57.8%). After a mean follow-up duration of 6 years after surgery, the surgical success rate was significantly higher in PA responders (76.7% vs. 54.2%, p = 0.023). By multivariate analysis, good stereoacuity at near before surgery significantly correlated with successful outcomes after surgery (p = 0.001, β = 4.466). The risk factors of undercorrection were preoperative esotropia >35 PD (OR 3.067, p = 0.041), and preoperative hyperopia >+5.25 diopters (OR 3.099, p = 0.049). Among undercorrected patients, the annual decrease of esodeviation was significantly greater in PA responders (p = 0.043). CONCLUSIONS PA responders showed a better long-term success rate than in PA nonresponders. Patients with high hyperopia and large esotropia had a higher risk of undercorrection. Undercorrected patients eventually achieved good motor outcome with postoperative prism correction if they were PA responders before surgery.
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Affiliation(s)
- Dong Hyun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Yoo YJ, Hwang JM, Yang HK, Joo JD, Kim YH, Kim CY. Prognostic value of macular ganglion cell layer thickness for visual outcome in parasellar tumors. J Neurol Sci 2020; 414:116823. [PMID: 32302803 DOI: 10.1016/j.jns.2020.116823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Optic nerve compression by mass lesions at the optic chiasm leads to loss of visual function which can be recovered after decompression surgery. In this study, we evaluated the prognostic ability of macular ganglion cell layer (mGCL) thickness measured with spectral-domain optical coherence tomography (SD-OCT) for predicting postoperative visual outcome of compressive optic neuropathy (CON) related to parasellar tumors. METHODS This observational cohort study used data from the Department of Neurosurgery and Ophthalmology, Seoul National University Bundang Hospital between 2013 and 2018. Seventy-nine eyes from 79 patients with CON due to parasellar tumors who underwent surgery were included. Patients were divided into either a visual recovery group or a non-recovery group according to the degree of postoperative visual field (VF) impairment. SD-OCT scanning with automated segmentation was performed to measure the circumpapillary retinal nerve fiber layer (cpRNFL) and the mGCL thickness in the nine macular subfields as defined by the ETDRS and 8 × 8 posterior pole grid. Correlations between preoperative cpRNFL thickness, mGCL thickness and postoperative VF sensitivity were assessed. The prognostic ability of mGCL thickness for predicting visual recovery after surgical decompression in each ETDRS subfield and posterior pole grid quadrant was evaluated. RESULTS The central inferonasal and superonasal quadrant mGCL thicknesses measured by the 8 × 8 posterior pole grid showed the best predictability of postoperative visual outcome (AUROC = 0.963 and 0.953, respectively), which was superior to the prognostic power of the average cpRNFL. The central inferonasal quadrant mGCL thickness significantly correlated with the superotemporal quadrant VF sensitivity (R2 = 0.589). CONCLUSIONS The mGCL thickness in the central nasal quadrants measured by SD-OCT is an excellent predictor of visual recovery after chiasmal decompression.
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Affiliation(s)
- Yung Ju Yoo
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University Graduate School of Medicine, Chuncheon, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Jin-Deok Joo
- Department of Neurosurgery, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Young-Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Hong EH, Yang HK, Kim JH, Hwang JM. Bilateral Fundus Excyclotorsion in Unilateral Superior Oblique Palsy Confirmed by MR Imaging. J Clin Med 2020; 9:jcm9061829. [PMID: 32545329 PMCID: PMC7356771 DOI: 10.3390/jcm9061829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/27/2020] [Accepted: 06/08/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose: To determine whether bilateral fundus excyclotorsion is helpful in distinguishing bilateral superior oblique palsy (SOP) from unilateral SOP by investigating bilateral fundus excyclotorsion in unilateral SOP and comparing the features with bilateral SOP using fundus photographs. Methods: This retrospective cohort study included a total of 212 subjects who were diagnosed with unilateral SOP with hypoplasia of a single superior oblique (SO) muscle and 7 subjects with clinically diagnosed bilateral SOP. Fundus excyclotorsion measured by modified fovea–disc angles and inter-eye differences in cyclotorsion angles (the difference in fundus excyclotorsion angles: paretic eye or hypertropic eye in primary gaze–fellow eye), and subjective cyclotorsion were compared between groups of unilateral SOP with bilateral fundus excyclotorsion (SOPBE) and bilateral SOP. Results: Bilateral fundus excyclotorsion was found in 18 out of 212 patients (8.5%) in the unilateral SOP group, and 7 out of 7 patients (100%) in the bilateral SOP group. Among the 25 patients with bilateral fundus excyclotorsion, the mean angle of excyclotorsion (5.7° ± 4.7° vs. 7.6° ± 4.3°, p = 0.125) and the inter-eye differences (0.7° ± 3.6° vs. 0.5° ± 5.8°, p = 0.615) were not significantly different between the unilateral SOPBE and bilateral SOP groups. The degree of subjective excyclotorsion was significantly larger in the bilateral SOP group compared with the unilateral SOPBE group (16.0 ± 5.5 vs. 4.6 ± 4.3, p = 0.002). Conclusion: Bilateral fundus excyclotorsion was demonstrated not only in bilateral SOP, but also in unilateral SOP at a rate of 8.5%. Bilateral fundus excyclotorsion alone did not prove to be a specific sign in distinguishing bilateral SOP from unilateral SOP.
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Affiliation(s)
- Eun Hee Hong
- Department of Ophthalmology, Hanyang University College of Medicine, Hanyang University Guri Hospital, 153, Gyeongchun-ro, Guri-si, Gyeonggi-do 11923, Korea;
| | - Hee Kyung Yang
- Departments of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea;
| | - Jae Hyoung Kim
- Departments of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea
- Correspondence: (J.H.K.); (J.-M.H.); Tel.: +(82)-31-787-7602 (J.H.K.); +(82)-31-787-7379 (J.-M.H.); Fax: +(82)-31-787-4057 (J.H.K. & J.-M.H.)
| | - Jeong-Min Hwang
- Departments of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea;
- Correspondence: (J.H.K.); (J.-M.H.); Tel.: +(82)-31-787-7602 (J.H.K.); +(82)-31-787-7379 (J.-M.H.); Fax: +(82)-31-787-4057 (J.H.K. & J.-M.H.)
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Lee EJ, Kim JA, Kim TW, Kim H, Yang HK, Hwang JM. Glaucoma-like Parapapillary Choroidal Microvasculature Dropout in Patients with Compressive Optic Neuropathy. Ophthalmology 2020; 127:1652-1662. [PMID: 32525046 DOI: 10.1016/j.ophtha.2020.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/13/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To characterize peripapillary choroidal microvasculature dropout (MvD) in patients with compressive optic neuropathy (CON) as compared with those with open-angle glaucoma (OAG) using OCT angiography (OCTA). DESIGN Cross-sectional, observational study. PARTICIPANTS Eighty-eight eyes of 44 patients with CON; 88 eyes of 88 patients with OAG matched by age, spherical error, and OCT-determined retinal nerve fiber layer thickness (RNFLT); and 88 eyes of 44 control participants matched by age and spherical error. METHODS Peripapillary microvasculature was evaluated, and peripapillary vessel density was measured in en face images segmented into inner-retinal and choroidal layers using swept-source OCTA. An MvD was defined as a focal sectoral capillary dropout with no visible microvascular network in the choroidal layer. MAIN OUTCOME MEASURES Comparative characteristics of MvD in eyes with CON and OAG. RESULTS Microvasculature dropout was observed in 30 eyes (34.1%) of 22 patients (50.0%) with CON, and in 48 eyes of 48 patients (54.5%) with OAG (P = 0.011). All MvDs in the CON group were located in the temporal parapapillary sector, whereas MvDs in the OAG group were located in the temporal-inferior (n = 36) and temporal-superior (n = 4) sectors. At their locations, MvDs in the CON group were accompanied by significant reductions in retinal vessel density and RNFLT, but this was not observed in the OAG group. The presence of MvD was associated significantly with female gender (P = 0.020) and thinner global retinal nerve fiber layer (P = 0.006) in the CON group, but not in the OAG group. CONCLUSIONS OCT angiography of the peripapillary area showed retinal and choroidal microvasculature impairment in patients with both CON and OAG. However, the features and associated characteristics of MvD differed between these groups, suggesting that the pathogenesis of peripapillary microvascular impairment may be diverse.
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Affiliation(s)
- Eun Ji Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji-Ah Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Tae-Woo Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Hyunjoong Kim
- Department of Applied Statistics, Yonsei University, Seoul, Republic of Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Hwang K, Kim YH, Kim JH, Lee JH, Yang HK, Hwang JM, Kim CY, Han JH. The outcomes of conservatively observed asymptomatic nonfunctioning pituitary adenomas with optic nerve compression. J Neurosurg 2020; 134:1808-1815. [PMID: 32502994 DOI: 10.3171/2020.4.jns192778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 04/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors investigated the natural history of asymptomatic nonfunctioning pituitary adenomas (NFPAs) with optic nerve compression. METHODS This study retrospectively analyzed the natural history of asymptomatic NFPAs with documented optic nerve compression on MRI diagnosed between 2000 and 2016 from 2 institutions. The patients were followed up with regular endocrinological, ophthalmological, and radiological evaluations, and the endpoint was new endocrinopathy or neurological deficits. RESULTS The study comprised 81 patients. The median age at diagnosis was 58.0 years and the follow-up duration was 60.0 months. As the denominator of overall pituitary patients, 2604 patients were treated with surgery after diagnosis at the 2 institutions during the same period. The mean initial and last measured values for tumor diameter were 23.7 ± 8.9 mm and 26.2 ± 11.4 mm, respectively (mean ± SD). Tumor growth was observed in 51 (63.0%) patients; however, visual deterioration was observed in 14 (17.3%) patients. Ten (12.3%) patients experienced endocrine deterioration. Fourteen (17.3%) patients underwent surgery for either visual deterioration (in 12 patients) or endocrine dysfunction (in 2 patients). After surgery, all patients experienced improvements in visual or hormonal function. The actuarial rates of treatment-free survival at 2, 3, and 5 years were 96.1%, 93.2%, and 85.6%, respectively. In the multivariate analysis, initial cavernous sinus invasion (HR 4.985, 95% CI 1.597-15.56; p = 0.006) was the only independent risk factor for eventual treatment. CONCLUSIONS The neuroendocrinological deteriorations were not frequent and could be recovered by surgery with early detection on regular follow-up in asymptomatic NFPAs with documented optic nerve compression on MRI. Therefore, conservative management could be an acceptable strategy for these tumors. Careful follow-up is required for tumors with cavernous sinus invasion.
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Affiliation(s)
| | | | - Jung Hee Kim
- 3Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Hyun Lee
- 3Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee Kyung Yang
- 4Ophthalmology, Seoul National University Bundang Hospital, Seongnam-si; and
| | - Jeong-Min Hwang
- 4Ophthalmology, Seoul National University Bundang Hospital, Seongnam-si; and
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Choi YJ, Choi JY, Yang HK. Orbital Apex Syndrome with Perinuclear Anti-neutrophil Cytoplasmic Antibody-associated Pachymeningitis. J Korean Ophthalmol Soc 2020. [DOI: 10.3341/jkos.2020.61.5.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Kim MS, Lee KM, Hwang JM, Yang HK, Woo SJ. Morphologic Features of Buried Optic Disc Drusen on En Face Optical Coherence Tomography and Optical Coherence Tomography Angiography. Am J Ophthalmol 2020; 213:125-133. [PMID: 31987902 DOI: 10.1016/j.ajo.2020.01.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate and compare the morphologic characteristics of buried optic disc drusen (ODD) and optic disc edema (ODE) by using en face optical coherence tomography (OCT) and OCT angiography (OCTA). DESIGN Retrospective, cross-sectional study. METHODS We reviewed the medical records of 61 patients (92 eyes) with buried ODD, 45 patients (62 eyes) with ODE, and 42 normal-appearing fellow eyes examined at 1 referral center between November 1, 2017 and April 30, 2019. Characteristic en face OCT and OCTA findings of buried ODD compared to those of ODE and normal optic discs were investigated. RESULTS On en face OCT, all buried ODD were visualized as hyperreflective kidney-shaped masses well demarcated from the optic nerve axons, whereas ODE was visualized as ill-defined boundaries confluent with the retinal nerve fibers. On OCTA, 25.0% of the eyes with buried ODD showed a C-shaped vessel density decrease in the nasal radial peripapillary capillary layer, while 40.3% of the eyes with ODE had nonspecific focal vessel density decrease around the optic nerve head. Larger ODD were significantly associated with a vessel density decrease on OCTA (P = .009). The disc diameter positively correlated with the ODD area (r = 0.245; P = .018) and negatively correlated with the ODD height (r = -0.237; P = .023). CONCLUSIONS En face OCT showed the characteristic features of buried ODD compared to those of ODE or normal optic discs. The demarcation of buried ODD from the optic nerve axons on en face OCT and the poor vascular perfusion of buried ODD on OCTA suggest that buried ODD are materials deposited around the optic disc rather than the herniated optic nerve axon fibers.
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Affiliation(s)
- Min Seok Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyoung Min Lee
- Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Yang HK, Lee YJ, Hyon JY, Kim KG, Han SB. Efficacy of bevacizumab injection after pterygium excision and limbal conjunctival autograft with limbal fixation suture. Graefes Arch Clin Exp Ophthalmol 2020; 258:1451-1457. [DOI: 10.1007/s00417-020-04704-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/02/2020] [Accepted: 04/13/2020] [Indexed: 11/28/2022] Open
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Kang MS, Yang HK, Kim N, Hwang JM. Clinical Features of Ocular Motility in Idiopathic Orbital Myositis. J Clin Med 2020; 9:jcm9041165. [PMID: 32325733 PMCID: PMC7231042 DOI: 10.3390/jcm9041165] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/02/2020] [Accepted: 04/10/2020] [Indexed: 12/24/2022] Open
Abstract
: Objective: To elucidate the clinical features of ocular motility and the risk factors for recurrence in idiopathic orbital myositis. METHODS The medical records of 31 patients diagnosed with idiopathic orbital inflammation between 2003 and 2019 were retrospectively reviewed. All patients were initially treated with corticosteroids. Treatment outcome and ocular motility were noted. RESULTS Twenty-six patients (84%) had unilateral involvement and five patients (16%) were bilateral. Of the 31 patients, 22 patients (71%) showed ocular motility limitation. The mean grading scale of extraocular muscle (EOM) limitation was -1.65 ± 1.80. EOM limitation was found in the same direction of the most affected muscle in 14 patients (64%), while 8 patients (36%) showed duction limitation in the opposite direction. Nine patients (35%) suffered from recurrence. Recurrence was more likely to occur in patients with multiple muscle involvement (p < 0.001). The interval to relapse of symptoms after discontinuation of steroids was significantly shorter in patients with multiple recurrences compared to those with a single recurrence (1.8 ± 0.8 weeks versus 6.0 ± 1.4 weeks, p = 0.020). CONCLUSIONS Idiopathic orbital myositis showed variable degrees of ocular motility limitation, and limitation in the same direction of the action of the affected muscle was more frequent. Recurrent myositis was more likely to have multiple muscle involvement. Rapid relapse of symptoms after discontinuation of steroids was a significant indicator of multiple recurrences.
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Affiliation(s)
- Min Seok Kang
- Department of Ophthalmology, Kim’s Eye Hospital, Seoul 07301, Korea;
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do 13620, Korea;
| | - Namju Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do 13620, Korea;
- Correspondence: (N.K.); (J.-M.H.)
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do 13620, Korea;
- Correspondence: (N.K.); (J.-M.H.)
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Yang HK, Woo SJ, Kim SJ, Hwang JM. Surgical outcomes of strabismus after iatrogenic ophthalmic artery occlusion caused by cosmetic filler injections. BMC Ophthalmol 2019; 19:254. [PMID: 31842812 PMCID: PMC6913019 DOI: 10.1186/s12886-019-1264-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the surgical outcomes of strabismus related to iatrogenic occlusion of the ophthalmic artery and its branches from cosmetic facial filler injection. METHODS A retrospective study was performed on 6 patients who underwent strabismus surgery among 23 patients who had suffered occlusion of the ophthalmic artery and its branches after cosmetic facial filler injection. Initial, preoperative and final ocular motility examinations, the type of surgery and surgical outcomes were evaluated. RESULTS At initial presentation, visual acuity was no light perception in 5 patients and hand motion in one patient. Five out of 6 patients showed initial ophthalmoplegia. Among these 5 patients, eye motility fully recovered in 3 patients although sensory strabismus developed during follow-up, while the remaining 2 patients had persistent ocular motility limitations. Strabismus surgery was performed at 2.2 ± 1.5 years after iatrogenic ophthalmic artery occlusion. Preoperatively, 5 of the 6 patients showed exotropia, and one patient had esotropia. Vertical deviation was found in 3 out of 6 patients in addition to the horizontal deviation. Successful outcome was achieved only in the 4 patients without persistent ophthalmoplegia after 1.4 ± 1.0 years from surgery. The other two patients with persistent ocular motility limitations failed to achieve successful alignment after surgery, and one patient eventually underwent evisceration due to phthisis bulbi. CONCLUSIONS In our study, surgical outcomes of strabismus caused by cosmetic facial filler injection were successful only in patients without persistent ophthalmoplegia at the time of surgery.
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Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, Republic of Korea.
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