• Journal of The Korean Ophthalmological Society
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• v.59 no.11
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• pp.1087-1090
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• 2018

Purpose: To report a case of trochlear nerve palsy caused by quadrigeminal cistern lipoma located in the dorsal midbrain. Case summary: A 65-year-old male visited our clinic for intermittent vertical diplopia over 2-year period. Symptoms of diplopia had worsened over the past two weeks. He had no previous medical history except having had diabetes for 1 month. The best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. Pupillary examination was not remarkable. Extraocular examination showed 4 prism diopters (PD) left hypertropia at distant gaze and 4 PD exotropia at near gaze, with adduction elevation of the left eye. The Bielschowsky head tilt test revealed 6 PD left hypertropia on the left gaze and orthotropia on the right tilt. Fundus examination showed excyclotorsion of the right eye and incyclotorsion of the left eye. Brain magnetic resonance imaging revealed quadrigeminal cistern lipoma. Prism glasses were prescribed to alleviate diplopia, and we followed up the lesions without further treatment. Conclusions: Trochlear nerve palsy can be caused by quadrigeminal cistern lipoma; however, it is uncommon for this condition to be caused by a compressive lesion. Prompt neuroimaging can be helpful to rule out the causes of this condition in patients with atypical symptoms.

• Journal of The Korean Ophthalmological Society
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• v.59 no.12
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• pp.1195-1200
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• 2018

Purpose: To report a case of anterior segment ischemia after superior and inferior rectus muscle surgery in a patient with superior rectus muscle enlargement. This is the first report in the Republic of Korea of anterior segment ischemia after two rectus muscles surgery. Case summary: An 80-year-old male was referred to our clinic with a 3 years history of diplopia. The patient had 30 prism diopters right eye hypertropia in the primary position and downgaze limitation. The orbital computed tomography scan revealed enlargement of the right superior rectus muscle. He underwent right superior rectus recession and inferior rectus resection. On postoperative day 2, slit lamp examination revealed diffuse corneal edema, Descemet's membrane folding, an aqueous flare and a dilated pupil. Treatment with 45 mg oral steroid was initiated, and 1% prednisolone acetate and 0.5% Levofloxacin eye drops were administered. At postoperative 1 month, the patient was orthophoric in the primary position, and there was no corneal edema, pupil abnormality or aqueous flare. Conclusions: Base on the present case, the possibility of anterior segment ischemia should be considered after even two muscles surgery, and older patients with vertical muscle surgery should be considered more carefully.

• Journal of The Korean Ophthalmological Society
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• v.58 no.11
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• pp.1313-1316
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• 2017

Purpose: To report fundus photography using a smartphone in an infant with abusive head trauma. Case summary: An 8-month-old male infant presented to the emergency room with decreased consciousness and epileptic seizures that the parents attributed to a fall from a chair. He had no external wounds or fractures to the skull or elsewhere. However, computerized tomography of the brain revealed an acute subdural hematoma in the right cranial convexity and diffuse cerebral edema, leading to a midline shift to the left and effacement of the right lateral ventricle and basal cistern. The attending neurosurgeon promptly administered a decompressive craniectomy. Immediately after the emergency surgery, a fundus examination revealed numerous multi-layered retinal hemorrhages in the posterior pole extending to the periphery in each eye. He also had white retinal ridges with cherry hemorrhages in both eyes. We acquired retinal photographs using the native camera of a smartphone in video mode. The photographer held the smartphone with one hand, facing the patient's eye at 15-20 cm, and held a 20 diopter condensing lens at 5 cm from the eye in the other hand. Our documentation using a smartphone led to a diagnosis of abusive head trauma and to obtain the criminal's confession, because the findings were specific for repetitive acceleration-deceleration forces to an infant's eye with a strong vitreoretinal attachment. Conclusions: This ophthalmic finding had a key role in the diagnosis of abusive head trauma. This case presented the diagnostic use of a smartphone for fundus photography in this important medicolegal case.

• Journal of The Korean Ophthalmological Society
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• v.60 no.5
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• pp.470-473
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• 2019

Purpose: To investigate the relationship between dominant eye and refractive error in patients with myopic anisometropia. Methods: This study population consisted of myopes less than 15 years old who were followed up for anisometropia defined as interocular difference of spherical equivalent (SE) ≥1.0 diopter (D). All patients underwent the hole-in-the-card test at far and near to determine ocular dominance. The data were analyzed for statistical significance using Fisher's exact test. Results: A total of 102 eyes in 51 patients were analyzed. The mean age of the patients was 10.4 ± 1.4 years and 54.9% were male. The mean SE was -2.97 ± 1.95 D in the right eye and -3.02 ± 1.92 D in the left eye. The right eye was the dominant eye in 43.1% and 37.3% at distance and near, respectively. The agreement of dominancy between distant and near was 82.4%. The near dominant eyes showed statistically significant accordance with more myopic eyes (p = 0.009). On the other hand, there was no statistically significant relationship between more myopic eyes and distant dominant eyes (p = 0.09). Conclusions: The near dominant eye was more myopic eye in patients with myopic anisometropia. This was considered to be related with the lag of accommodation in dominant eye with near distance.

• Journal of Korean Ophthalmic Optics Society
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• v.12 no.3
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• pp.39-48
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• 2007

The stimulus of accommodation A, the stimulus of convergence C and the prism diopter ${\Delta}$ are reviewed and redefined more obviously. How the A and C are managed in the practice are reviewed and summarized. As a result, the common practical process of the binocular vision findings is most suitable in the case of the $l_c=26.67mm$, where the near distance is measured from the test lens to the near target and its value is 40 cm and the average of the P.D equal to 64 mm. The $l_c$ is the distance between the test lens and the center of rotation. Those values were used at calculating the various values in this paper. The error of the stimulus of accommodation values which are evaluated by the practically used formula (5) are calculated. Where the distance between lens and the principle point of eye is 15.07 mm ($=l_H$). The incremental stimulus of convergence values P' caused by the addition prism $P_m$ are evaluated by the recursion computation method. The P' are varied with the $P_m$, the distance $p_c$ between the prism and the center of rotation, the initial convergence value (or inverse target distance) $C_o$ and the refractive index n of the prism material. The recursion computation method and the other formulas are described in detail. In this paper n=1.7 is used. The two factors by which the P' is increased are exist. The one which is major is the property by which the values of convergence whose unit is ${\Delta}$ are not added in the generally way. The other is the that the actual power of the prism is varied with the angle of incidence light. And the P' is decreased remarkably by an increase in the $p_c$ and $C_o$. The $P^{\prime}/P_m$ are calculated and graphed which are varied with the $p_c$ and $C_o$, where the $P_m=20{\Delta}$, P.D=64 mm and n=1.7. The index n dependence of the $P^{\prime}/P_m$ is negligible (refer to fig. 6). The $p_c$ are evaluated at which the P' equal to the $P_m$ for various $P_m$ (refer to table 1). The actual values of the stimulus of convergence and accommodation which are manipulated simply in the practice are calculated. Two graphical forms are suggested. The one is like as the commonly used one. But the stimulus of convergence and of accommodation values in the practice are positioned at the exact positions when the graphic is made (refer to fig. 9). The other is the form that the incremental stimulus of convergence values caused by the addition prisms are represented at actual positions (refer to fig. 11).

• Journal of The Korean Ophthalmological Society
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• v.59 no.11
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• pp.1009-1016
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• 2018

Purpose: To assess the effect on axial elongation and associated factors between spectacles and of orthokeratology lens (OK) wearing in children with mild to moderate myopia. Methods: A total of one hundred subjects, ranging in age from 6 to 13 years, and with mild to moderate myopia no more than -4.50 diopters in spherical equivalent, visited our clinic from 2013 to 2015. The OK group (75 eyes) and the spectacles group (64 eyes) were compared and analyzed on the axial elongation and associated factors. Results: In the OK group, axial length was elongated in 1 year period with a mean increase of $0.24{\pm}0.29mm$. In spectacles group, axial length was elongated in 1 year period with a mean increase of $0.42{\pm}0.20mm$. The statistically significant suppression of axial elongation was observed in OK group compared to the spectacles group (Mann-Whitney U test, p < 0.05). For OK group, the age of starting OK (Pearson's correlation, r = -0.481, p < 0.05) was the only influencing factor on axial elongation, which had negative correlation with axial elongation. In spectacles group, the age of starting spectacles had negative correlation with axial elongation (Pearson's correlation, r = -0.462, p < 0.05) and baseline spherical equivalent, spherical diopter, cylindrical diopter from manifest refraction had positive correlation with axial elongation. Comparison of axial elongation in orthokeratology lens group and spectacles group by age groups (6 to 9 years [28 eyes], 9 to 13 years [47 eyes]), 9 to 13 years of orthokeratology lens group had the stronger suppression of axial elongation (Mann-Whitney U test, p < 0.05). Conclusions: The OK effectively suppresses axial elongation compared to the spectacles. Although the patients are in age from 9 to 13 years, the axial elongation was effectively suppressed.