Spontaneous subconjunctival orbital fat prolapse: report of three cases

Spontaneous subconjunctival orbital fat prolapse is an uncommon but benign entity. It is seldom discussed in the literature, and is sometimes confused with other ocular surface tumors, such as dermolipoma. We present 3 cases, two of which are bilateral, the other being unilateral. Two cases underwent surgical excision due to ocular irritation, and the pathology proved mature adipose tissue compatible with the diagnosis. Computed tomography (CT) was available for 1 case and revealed a fat-compatible radiolucent mass continuous with the intraconal fat. Some other reports have presumed that the intraconal fat was prolapsed from a dehiscence of Tenon's capsule. However, according to our surgical findings, we suggest that the possible weak point for intraconal orbital fat prolapse is between the regions where the rectus muscle tendons penetrate into Tenon's capsule. The fat just bulges anteriorly, but not penetrates the Tenon's capsule and the intermuscular septum.

A traumatic macular hole secondary to a high-energy Nd:YAG laser

A case is reported of a traumatic macular hole caused by a high-energy Nd:YAG laser. The initial ocular examination revealed an explosive, crater-shaped, full-thickness macular hole surrounded by local edema and detachment. By the 12th day after the injury, the hole had shrunk progressively and was covered by a thin fibrin-like membrane. A thick epiretinal membrane covered the injured area 1 month after the injury. Nine months after the injury, the macular hole closed spontaneously with a partially detached epiretinal membrane. This case demonstrates one of the natural healing processes of a traumatic macular hole. Although the hole finally closed, the patient did not regain his vision because of the severe damage to the photoreceptors, retinal pigment epithelium, and choroid.

Endogenous Klebsiella pneumoniae endophthalmitis associated with prostate abscess: case report

A young alcoholic and heavy smoker was admitted because of Klebsiella pneumoniae bacteremia. The abdominal and pelvic computed tomography with enhancement revealed an abscess in the right prostate. He experienced blurred vision of his left eye on the third day during admission. Initial ocular examination revealed mild reaction in the anterior chamber and vitreous as well as multiple Roth's spots in the retina. The administration of empirical antibiotics including cefazolin and gentamicin intravenously was changed to ceftriaxone and amikacin after ophthalmologic consultation. After parenteral antibiotics for 3 weeks, the systemic condition was controlled, and the vision remained stable. During the past decades, many cases of endogenous Klebsiella pneumoniae endophthalmitis associated with liver abscess were reported in Taiwan. However, documented reports of this condition associated with a prostate abscess are rare. This case, classified as posterior focal endogenous endophthalmitis, had good prognosis under appropriate antibiotic treatment. Early diagnosis and prompt therapy are important for control of sepsis and restoration of vision.

Inhibition of telomerase activity by PKC inhibitors in human nasopharyngeal cancer cells in culture

Telomerase is a specialized ribonucleoprotein polymerase that adds hexanucleotides (TTAGGG) onto human chromosomal ends. The expression of telomerase activity has been associated with cell immortalization and the malignant phenotype in most cancers. How the telomerase activity is regulated in cancer cells is presently not known. In this work, the effects of cell cycle blockers, DNA damaging agents, TopII inhibitors and proteins kinase inhibitors on the telomerase activity were examined in cultured nasopharyngeal carcinoma cells NPC-076. Agents which interfere with tubulin assembly (Taxol and vinblastine) and agents which arrest cells at S phase (methotrexate and 5-fluorouracil) did not inhibit telomerase activity of treated cells. Agents which damage DNA (cisplatin, methyl methanesulfonate, and UV radiation) and TopII inhibitors (etoposide and daunorubicin) also did not inhibit telomerase activity of treated cells. Among the protein kinase inhibitors examined, no significant inhibition of telomerase activity was observed with cells treated with quercetin, H-89, or herbimycin A. On the other hand, two protein kinase C (PKC) inhibitors (bisindolylmaleimide I and H-7) were found to produce a big inhibition of telomerase activity in treated cells. Staurosporine produced a moderate inhibition, and sphingosine had a small inhibitory effect. The inhibition of telomerase activity by PKC inhibitors appears to be specific since the treated cells were mostly viable (i.e., greater than 75%) and still retained significant levels of protein synthesis capability. These results implicate that protein kinase C is involved in the regulation of telomerase activity in vivo.

Neglect of childhood strabismus: Keelung Ann-Lo Community ocular survey 1993-1995

Strabismus is a major cause of amblyopia. Parents not aware of the adverse outcome of untreated strabismus is thought to be a major reason of their affected child not being discovered earlier. An ocular survey was therefore conducted to examine the relative neglect of strabismus by the public, using myopia as a reference eye disorder. Specific objectives included estimating the prevalence of these ocular diseases, comparing the self-reported rate to the test-based rate, and investigating how much parents knew about these ocular diseases. Between 1993 and 1995, 862 elementary students in the first, third, and sixth grade at Keelung Ann-Lo Community were screened. The prevalence of manifest strabismus was 1.62% (95% CI = 1.19% approximately 2.05%). Of those with strabismus, three (21.4%) knew that they had strabismus. Neither the prevalence nor the self-known proportion of strabismus changed substantially with school grade, suggesting that the majority of strabismus afflicted children remain unrecognized during their elementary school years. The amblyopia proportion in those with tropia was 42.9% and reduced to 21.5% after abnormal refractive error was excluded. Of six knowledge statements about each ocular disorder, parents answered 2.13 (SD = 1.40) strabismus statements correctly, which was significantly less than their response on myopia statements (4.32 with SD = 1.24) (p < .0001). Onset age of strabismus was the question answered least correctly, implying that parents are not aware of the timing of treating strabismus. Our findings suggest that childhood strabismus was neglected by the public before the implementation of National Health Insurance (NHI). Should a similar study continued to be conducted in the future, the efficacy of NHI in the early recognition and treatment on childhood strabismus can be evaluated.

Clinical application of simultaneous pattern VEP and pattern ERG recording

Thirteen eyes of optic neuropathy and 13 eyes of maculopathy during Sep. 1990-May 1992 were studied by simultaneous pattern VEP (PVEP) and pattern ERG (PERG) recording. In optic neuropathy, the P100 of PVEP was delayed in 7 eyes (ave. 108.87 msec; normal 94.41 +/- 3.51 msec), absent in 5 eyes, normal in 1 eye. Their PERG showed normal P50 amplitude (either normal or delayed latency) but small or absent N95 in 8 eyes. In maculopathy, the P100 of PVEP was delayed in 2 eyes (ave. 103.59msec), absent in 7 eyes, normal in 4 eyes. However, their PERG showed 12 eyes had small or absent P50. Combined PVEP & PERG test, when compared to PVEP alone, increased the diagnostic value from 57.1% to 100% for optic neuropathy and from 42.9% to 80% for maculopathy in this study. Thus, simultaneous PVEP & PERG recording is highly recommended in evaluation of anterior visual pathway disorders.

Disappearance of Kayser-Fleischer rings following liver transplantation

1. Four cases of Kayser-Fleischer rings of Wilson's disease were observed to disappear after liver transplantation. 2. The disappearance of Kayser-Fleischer rings was in reverse order from that in which they appear. 3. The duration of disappearance was variable. 4. The density of Kayser-Fleischer rings correlated with the duration of clinical symptoms.

Neonatal morphine withdrawal syndrome: report of two cases

Two siblings born to a morphine-addicted mother with morphine withdrawal syndrome were reported. The first child, a female, presented with irritability, jitteriness and watery diarrhea at three days of age. The second, a male, presented with jitteriness and irritability when twelve hours old. Both cases were managed with supportive care; phenobarbital was given for the first case. These two cases and the literature concerning neonatal morphine withdrawal syndrome are reviewed.

[5-Fluorouracil in trabeculectomy: preliminary report]

Subconjunctival 5-FU injections were used as an adjunctive therapy in trabeculectomy for high risk glaucoma patients. We injected 5 mg once a day for five to seven days as a routine treatment. For the first 10 eyes, the injections were started immediately after the operation. However, for the remaining 9 eyes, the injections began 24 to 48 hours postoperative. If the appearance of the bleb was not prominent or enriched in vascularity, the duration of the injections should be extended to 10 to 14 days. At least 8 months of follow-up were available for 19 eyes, including aphakic glaucoma, 8 eyes; neovascular glaucoma, 2 eyes; previous failed filter, 6 eyes; total collapse of the anterior chamber with leucoma adherence, 1 eye; glaucoma due to mesodermal dysgenesis, 1 eye; and juvenile glaucoma, 1 eye (whose fellow eye had received twice failed filtering procedures). The results revealed a success rate of 79% (intraocular pressure below 22mmHg with or without topical medication). The success rate for aphakic glaucoma was 63% (5/8), for neovascular glaucoma 100% (2/2) and for the failed filters 83% (5/6). We also presume that 5-FU injections would be effective in the treatment of to abnormally marked fibrous proliferations caused by age factors. The complications related to the use of 5-FU include corneal epithelial defect 4/9 (21%), conjunctival leak 3/9 (16%), subconjunctival hematoma 1/19 (5%), and conjunctival sterile ulcer 1/19 (5%).