PurposeThis study aimed to evaluate the clinical course and prognostic factors of acquired third, fourth, and sixth cranial nerve (CN) palsy grouped according to etiology.MethodsThis study involved a retrospective review of the medical records of 153 patients who were diagnosed with acquired paralytic strabismus from January 2004 to July 2015. Outcomes, recovery rates, and time to recovery were investigated according to the affected CN: CN3, CN4, and CN6 palsies. The patients were classified into four groups based on etiology: idiopathic, traumatic, neoplastic, and vascular.ResultsThe mean age of the patients was 59.8 ± 14.5 years and the mean follow-up period was 10.8 months. Out of the 153 patients, 63 (41.2%) had CN3 palsy, 35 (22.9%) had CN4 palsy, and 55 (35.9%) had CN6 palsy. The most common causes were vascular related (54.9%), followed by idiopathic (28.1%), trauma (8.5%), and neoplasm (5.88%). About 50% of the patients recovered within six months. Among the four etiologic groups, the idiopathic group showed the best prognosis because about 50% of the patients in this group recovered within three months. This was followed by the vascular, traumatic, and neoplastic groups. Cox proportional hazard analysis revealed a significant association between the baseline prism diopter and recovery rate.ConclusionsThe prognosis and natural history of paralytic strabismus vary depending on its cause. The vascular group had the best recovery rate and shortest recovery time, whereas the neoplastic group required the longest time to recover.
Neovascular age-related macular degeneration (AMD) is the leading cause of irreversible blindness in elderly population. Several classifications schemes have been developed to provide subtypes of neovascular AMD, which are known to be associated with visual prognosis. However, there is still a large proportion of patient with ambiguous findings according to current classification criteria. In this study, we classified treatment-naïve neovascular AMD patients using novel angiographic classification system and investigated the incidence and clinical characteristics of AMD subtypes. Among 339 eyes, five AMD subtypes were identified: 41 (12.1%) with classic choroidal neovascularization (CNV), 30 (8.8%) with occult CNV, 91 (26.8%) with microaneurysmal choroidal vasculopathy (MCV), 123 (36.3%) with polypoidal choroidal vasculopathy (PCV), and 54 (15.9%) with retinal angiomatous proliferation (RAP). MCV was younger than RAP ( P < 0.001). Classic CNV presented with worse visual acuity compared with MCV at baseline ( P < 0.001). Central macular subfield thickness was highest in RAP, and lowest in MCV ( P = 0.036). Subfoveal choroidal thickness was highest in MCV, and lowest in RAP ( P < 0.001). There was a significant difference in visual acuity at 12 months among five subtypes ( P = 0.046). Our results highlight the importance of angiography for identifying AMD subtypes, particularly the novel MCV group being distinct from other subtypes.
Corneal astigmatism was affected more by inner incision distance than outer incision distance, and a larger change in the posterior SIA was noted with decreasing inner incision distance. During cataract surgery, the position of the inner corneal incision should be considered rather than the outer incision. [J Refract Surg. 2017;33(7):460-468.].
PurposeTo evaluate the efficacy of focal verteporfin photodynamic therapy (PDT) in patients diagnosed with chronic central serous chorioretinopathy (CSC).MethodsThis study enrolled 52 eyes of 52 patients with chronic CSC who had received verteporfin PDT. The laser spot size of 26 eyes covering only the localized hyperfluorescent area in indocyanine green angiography was classified as focal PDT. The PDT spot size of the other 26 eyes covered the total area of retinal pigment epithelial detachment including the leaking point and was defined as conventional PDT. The central subfield thickness and subfoveal choroidal thickness were measured using Heidelberg Spectralis optical coherence tomography before PDT and at months 1, 3, 6, and 12 after PDT.ResultsThe mean spot size of the PDT was 1,995 µm in the focal group and 2,995 µm in the conventional group. Central subfield thickness steadily decreased in both groups. The mean baseline subfoveal choroidal thickness for the two groups was 334.95 and 348.35 µm, respectively, with no significant difference (p = 0.602). Subfoveal choroidal thickness decreased significantly to 304.20 µm at 1 month, 284.85 µm at 3 months, 271.60 µm at 6 months, and 265.95 µm at 12 months in the focal group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively, compared with baseline). In the conventional group, subfoveal choroidal thickness decreased significantly to 318.75, 300, 284, and 272 µm at 1, 3, 6, and 12 months, respectively (p < 0.001, p < 0.001, p < 0.001 and p < 0.001 compared with baseline). There were no significant differences between the two groups in subfoveal choroidal thickness based on PDT spot size at 1, 3, 6, and 12 months (p = 0.633, p = 0.625, p = 0.676, and p =0.755, respectively).ConclusionsFocal verteporfin PDT for CSC significantly decreased the subretinal fluid and sufoveal choroidal thickness to the same extent as conventional PDT.
Purpose: To investigate the correlation between Sjögren syndrome (SS) duration and ocular surface parameters in patients with SS-related dry eye.Methods: We analyzed 108 eyes of 108 female patients with primary SS-related dry eye. Meibomian gland (MG) dysfunction, MG dropout, lipid layer thickness (LLT), partial and total blinking, and partial blinking rate (PBR) were measured using a LipiView ® II ocular surface interferometer (TearScience, Morrisville, NC, USA). All patients underwent rheumatoid serologic tests and ocular surface assessments.The ocular surface assessment included the Standard Patient Evaluation of Eye Dryness (SPEED), Schirmer's I test, non-invasive tear break-up time, and grading of corneal/conjunctival staining. The correlations between SS duration and MG dropout rates as well as other ocular surface parameters were determined.Results: The mean SS duration was 54.1±41.3 months. There was a strong positive correlation between SS duration and MG dropout (r = 0.766, p < 0.001). The average, maximum, and minimum LLTs showed a weak negative correlation with SS duration (r = -0.310, -0.211, and -0.304, respectively, p = 0.014, 0.028, and 0.022, respectively) and MG dropout (r = -0.191, -0.326, and -0.299, respectively, p = 0.049, 0.002, and 0.009, respectively). Signi cant positive correlations were also observed between the SPEED scores and SS duration (r = 0.303, p = 0.042) and MG dropout (r = 0.450, p = 0.029).Conclusions: Longer durations of primary SS-related dry eye were associated with worse MG dysfunction.
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