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Purpose: Retinal laser photocoagulation is used to treat a variety of retinal diseases. Breakdown of the blood-aqueous barrier has been noted after retinal laser photocoagulation. The effect of vascular endothelial growth factor (VEGF) on the function of the blood-aqueous barrier after retinal laser photocoagulation remains undetermined. The current study was designed to evaluate the relationship between intraocular levels of VEGF and breakdown of the blood-aqueous barrier after retinal laser photocoagulation in rabbits.Methods: Pigmented rabbits were treated with retinal laser photocoagulation in one eye; the other served as control. Laser flare photometry was carried out on post-treatment days 1, 3, 7, and 14. Animals were sacrificed at the time period just mentioned postlaser, the eyes were removed, and samples of vitreous and aqueous humor were collected. Intraocular VEGF levels were measured by using an immunoassay. An intravitreal injection of VEGF was administered, and the aqueous flare intensity and VEGF levels in the aqueous and vitreous humor were measured at the time periods just mentioned.Results: A significant increase in the aqueous flare intensity after retinal laser photocoagulation was noticed on postoperative day 1, with the values returning to baseline levels on day 14. The VEGF levels in the vitreous of the lasered eyes were significantly increased on day 1 compared with the nonlasered control eyes. The VEGF levels in the aqueous humor of the lasered eyes were also significantly increased on day 1 compared with the control eyes. An intravitreal injection of VEGF induced a significant increase in the aqueous flare intensity and VEGF levels in the aqueous and vitreous humor.Conclusions: The current results suggested that retinal laser photocoagulation can produce a breakdown of the blood-aqueous barrier. VEGF may play a role in the blood-aqueous barrier dysfunction after retinal laser photocoagulation. [ABSTRACT FROM AUTHOR]

The purpose was to determine whether there was a breakdown of the blood-aqueous barrier in a patient with choroideremia. A 27-year-old man with typical choroideremia underwent standardized ophthalmo-logical evaluation, including quantitative measurement of aqueous flare intensity, by a laser flare-cell meter. The results showed areas of atrophy of the choriocapillaries and retinal pigment epithelium in the mid-periphery and posterior pole, although not in the macula. Fluorescein angiography showed areas of loss of the choriocapillaries and retinal pigment epithelium. The fovea was spared with a surrounding zone of hy-perfluorescence. Electroretinography showed a subnormal photopic amplitude and extinguished scotopic response. Electrooculography revealed that the light peak/dark trough ratio was reduced. Goldmann perimetry showed constricted peripheral fields. Laser photometry showed an increase in the aqueous flare intensity in both eyes, as compared with normal subjects. We conclude that the function of the blood-aqueous barrier might be affected in patients with choroideremia., ((c) 2010 Formosan Medical Association & Elsevier. Published by Elsevier B.V. All rights reserved.)

Background and Objective: To evaluate the efficacy of intraocular gas tamponade and macular grid laser photocoagulation to manage recurrent macular hole retinal detachment after an initially successful reattachment by gas tamponade in highly myopic eyes., Patients and Methods: Five patients with high myopia and macular hole retinal detachment were treated by gas tamponade at the initial operation. Gas tamponade and macular grid laser photocoagulation were performed to treat recurrent retinal detachment at the second surgery. Demographic information, anatomic reattachment of the retina, and final visual acuity were studied., Results: Final successful retinal reattachment at the end of follow-up was obtained in all five eyes. Improvement of postoperative visual acuity with respect to preoperative visual acuity was observed in all patients., Conclusion: Intraocular gas tamponade and grid laser photocoagulation in the macula for the management of recurrent macular hole retinal detachment provides good long-term anatomic success and acceptable functional results.

We report a rare case of retinal detachment with microphthalmos and choroidal coloboma. A 28-year-old man who had suffered from poor vision since early childhood was examined because of progressive deterioration of vision in his right eye. Examination of the anterior segment showed microphthalmos with microcornea and coloboma of the iris. Fundus examination revealed an inferior choroidal coloboma extending to the optic disc. The patient also had total bullous retinal detachment. Pars plana vitrectomy with silicone oil tamponade was performed, and the retina was reattached. Although rare, retinal detachment may develop in patients with microphthalmos and choroidal coloboma. Pars plana vitrectomy with additional scleral encircling buckle may be performed to treat this condition.

A laser flare-cell meter was used to examine blood-aqueous barrier function in a 57-year-old male patient who had typical reticular dystrophy of the retinal pigment epithelium with a bilateral hyperpigmented reticular pattern at the posterior pole in both eyes. Fluorescein angiography showed hypofluorescent reticular net resembling a fishing net with knots associated with a central diffuse hyperfluorescence. Dark adaptation test revealed that the final rod threshold was elevated. Laser photometry showed an increase in the aqueous flare intensity in both eyes, as compared to the results in normal subjects. Quantitative measurement of the aqueous flare intensity by a laser flare-cell meter might indicate abnormalities in the blood-aqueous barrier in patients with reticular dystrophy of the retinal pigment epithelium.

We report extensive myelinated retinal nerve fibers in a 42-year-old patient with retinal detachment. Fundus examination revealed a horseshoe-shaped tear near the temporal edge. Pars plana vitrectomy was performed and firm vitreo-retinal adhesion was noticed in the area of extensive myelinated retinal nerve fibers. Following vitrectomy with silicone oil tamponade, the retina was reattached successfully. In conclusion, retinal detachment may develop in patients with extensive myelinated retinal nerve fibers. Vitrectomy may be performed to treat this condition.

Clinical data showing breakdown in the blood-aqueous barrier in patients with combined hamartomas of the retina and retinal pigment epithelium are very limited. We used a laser flare-cell meter to examine blood-aqueous barrier function in a 35-year-old male patient who had typical combined hamartomas of the retina and retinal pigment epithelium characterized by an ill-defined, slightly elevated, grey-white epipapillary lesion with overlying glial proliferation and surrounding vascular tortuosity. Fluorescein angiography showed early hypofluorescence corresponding to the pigmented area with speckled hyperfluorescence in the lesion. Prominent retinal vascular tortuosity and late dye leakage were noted in the late phase. Visual evoked potential demonstrated poor waveform. Laser photometry showed an increase in the aqueous flare intensity in the affected eye, as compared to the results in the unaffected eye and to data from normal subjects. The increase in the aqueous flare intensity in this patient suggests that the function of the blood-aqueous barrier may be affected in combined hamartomas of the retina and retinal pigment epithelium.

Aims: To present transcaruncular medial orbitotomy as the preferred approach to manage frontoethmoid mucoceles., Methods: 11 patients with frontoethmoid mucoceles received transcaruncular orbitotomy from 2000 to 2002 at the National Taiwan University Hospital. The incision was made through the caruncle to explore the medial wall periosteum. Then the periosteum was opened and extended to provide adequate surgical field exposure. Frontoethmoid mucoceles could be viewed and removed directly. A transnasal drainage tube was inserted before closure of the caruncle wound., Results: The mean follow up period was 12 (SD 9.1) months (range 1-26). Both functional recovery and cosmetic outcome were excellent. There was no recurrence of mucoceles. One patient complained of diplopia, which subsided after 2 months., Conclusion: Transcaruncular orbitotomy provides a wide exposure and a safe access to the medial orbital extraperiosteal space. Furthermore, there is less damage to skin and muscle layer and less manipulation of other ocular adnexal structures, such as medial canthal tendon and lacrimal sac. It can be an excellent approach for the management of frontoethmoid mucoceles.

Aims: To describe the clinical characteristics of patients with eyelid cancers in Taiwan., Methods: Between 1980 and 2000, 127 (58 males and 69 females) patients (mean age 62.6; range 10-91 years) with histologically confirmed eyelid cancers were retrospectively evaluated at the National Taiwan University Hospital and Far Eastern Memorial Hospital in Taiwan. Clinical data of all patients were reviewed from medical records. The mean follow-up period was 62.4 months (range 3-240) for 113 patients., Results: The 127 eyelid cancers included 79 basal cell carcinomas (62.2%), 30 sebaceous gland carcinomas (23.6%), 11 squamous cell carcinomas (8.7%), five malignant melanomas (3.9%), one Kaposi's sarcoma (0.8%), and one metastatic cancer (0.8%). Tumours developed more commonly in the lower (37.0%) than the upper eyelid (33.9%). The clinical accuracy in predicting eyelid malignancy was 90.5%. Primary treatment modality was mainly surgical excision. The recurrence, metastasis, and mortality rates at 5 years were 15.2, 11.7, and 7.3%, respectively, for all eyelid malignancies. Rates of sebaceous gland carcinoma recurrence, metastasis, and mortality were significantly higher (P<0.05) than those of basal cell carcinoma. The mean interval of recurrence or metastasis after primary treatment was 26.3 months (range 4-112) for all eyelid cancers., Conclusions: Although basal cell carcinoma is the most common eyelid cancer in Taiwan, sebaceous gland carcinoma is also common. Of the two, basal cell carcinoma has a better prognosis and sebaceous gland carcinoma has a higher mortality and therefore should be treated much more aggressively. Long-term follow-up is needed after treatment of malignant eyelid tumours.

A laser flare-cell meter was used to examine blood-aqueous barrier function in a 21-year-old male patient who had typical retinitis punctata albescens with white dots scattered throughout large areas of the fundus in both eyes. Fluorescein angiography showed multiple areas of hyperfluorescence over dot lesions and window defects. Electroretinogram demonstrated subnormal amplitude and electrooculogram showed a reduced light-peak/dark-trough ratio. Goldmann perimetry revealed constricted peripheral fields. Laser photometry showed an increased aqueous flare intensity in both eyes compared to results in 10 normal subjects. Quantitative measurement of the aqueous flare intensity by a laser flare-cell meter might indicate abnormalities in the blood-aqueous barrier in patients with retinitis punctata albescens.

Twenty-five patients presenting with stage I primary orbital and/or ocular adnexal lymphoma from May 1990 through January 1997 were retrospectively reviewed at National Taiwan University Hospital. Staging workups included physical examination, chest radiography, blood analysis, whole-body CT scan, CSF examination and bone marrow biopsy. The histological types, based on the National Cancer Institute working formulation, were 17 cases of low-grade and 8 of intermediate lymphoma. Twenty patients received radiotherapy, while five cases refused. All patients except two received a radiation dose of 40 Gy, the other two received 30 Gy. The mean follow-up period was 4.7 +/- 1.6 years (2-8 years). Local control of disease was achieved in all 20 patients, but one patient with low-grade lymphoma developed disseminated disease with parotid gland, bone marrow and lung involvement 43 months after radiotherapy. Two out of five patients who refused treatment with radiotherapy developed systemic involvement 24 months and 18 months after diagnosis. Dry eye (45%) and cataract formation (35%) were among the most frequent complications in this study. One patient developed a recalcitrant trophic corneal ulcer and ultimately required corneal transplantation. In conclusion, radiotherapy is a safe and effective local treatment in the management of primary orbital or adnexal lymphoma.

Aim: To evaluate the complications associated with pegging of porous hydroxyapatite orbital implants., Methods: Complications associated with pegging were retrospectively reviewed from the charts of 100 of 133 patients with hydroxyapatite implantation from 1993 to 2000., Results: 48 (48%) of the 100 hydroxyapatite implanted patients who had undergone pegging were found to have problems with their pegs, including discharge (45.8%), peg falling out (20.8%), pyogenic granulomas (16.7%), popping peg (14.6%), hydroxyapatite visible around peg hole (8.3%), part of peg shaft visible (6.2%), peg drilled off centre (6.2%), peg drilled at an angle (4.2%), and excess movement of peg (4.2%). The standard peg fell out statistically more often than the peg and sleeve system (Yates's corrected chi(2), p=0.038). There was a trend towards complications of the peg with use of a standard peg (versus sleeved peg) (p=0.226)., Conclusions: There are several potential complications of pegging. Most complications are minor and can be managed successfully.

Orbital decompression was performed on 116 orbits with Graves' ophthalmopathy. The indications for decompression were dysthyroid optic neuropathy (DON), recalcitrant corneal exposure (EXP) and disfiguring exophthalmos (COS). All cases but one (in the DON group) had improved or unchanged vision. The average retinal sensitivity improvement in the DON group was 6.7 +/- 6.1 dB and 85% had a significant retinal sensitivity improvement (>5 dB). The average retroplacement effect was 4.4 +/- 2.1 mm and only five cases (7%) had postoperative asymmetry of more than 2 mm by Hertel's exophthalmometry. The most frequent sequela was diplopia, which tended to occur in more severely myopathic eyes. In our series, 21% (10/48 cases without preoperative diplopia) developed diplopia after decompressive surgery. Hypoglobus is another complication, noted in two cases, which was successfully repositioned. In conclusion, decompressive surgery is a safe and effective procedure to restore vision and reduce exophthalmos in Graves' ophthalmopathy. Careful evaluation of clinical parameters, individualization of surgical goals and intraoperative titration of the retroplacement effect are the key to optimal results.

Aims: To evaluate the long term results of intraoperative mitomycin C application in dacryocystorhinostomy (DCR) surgery compared with results of the conventional procedure., Methods: In this prospective randomised controlled study, a total of 88 eyes diagnosed with acquired nasolacrimal duct obstruction were randomly divided into a conventional DCR group and a mitomycin C group in which mitomycin C was used during DCR surgery. The surgical procedures in both groups were exactly the same, except that in the patients in the mitomycin C group, a piece of neurosurgical cottonoid soaked with 0.2 mg/ml mitomycin C was applied to the osteotomy site for 30 minutes. The results of the DCR surgeries were evaluated by objective findings such as irrigation and the height of tear meniscus and subjective symptoms by asking patients the condition of tearing improvement., Results: Among the 44 eyes in the mitomycin C group, 95.5% of patients remained totally symptom free after 10 months of follow up; while in the conventional group, 70.5% of patients were reported to be symptom free and 18% of patients to have an improvement in their symptoms. There was a significant difference between these two groups. As far as objective findings were concerned, there were 41 eyes in the mitomycin C group classified as having a normal and one eye with moderate tear meniscus level, compared with 32 eyes and seven eyes, respectively, in the conventional group. There was also a significant difference between these two groups. The non-patency rate in the mitomycin C group is 4.5% compared with 11.4% in the conventional group. There were no complications such as abnormal nasal bleeding, mucosal necrosis, or infection except one patient with delayed wound healing., Conclusions: Intraoperative mitomycin C application is effective in increasing the success rate of DCR surgery in standard nasolacrimal duct obstruction, and no significant complications resulted from its use.

Purpose: In order to understand and update the prevalence of myopia in Taiwan, a nationwide survey was performed in 1995., Methods: We stratified the cluster sampling by developmental grading of the city, using a size proportional to the population. Two cities were randomly selected from each city grading. The total number of students enrolled was 11,178, including 5,676 boys and 5,502 girls. The refractive status and corneal radius of each student were measured with an autorefractometer under cycloplegia and checked with retinoscopy. Axial length was measured with biometric ultrasound., Results: The myopic rate was from 12% at the age of 6, it increased to 56% at the age of 12, and then to 76% at the age of 15. A myopic rate of 84% was found for the age range of 16 to 18. The prevalence of high myopia (over -6.0 D) at the age of 18 was 20% in girls and 12% in boys. The mean refractive status became myopic at the age of 9, then increased to -3.92 D in girls and -2.71 D in boys at the age of 18. The increase of axial length is correspondent with the progression of myopia. The anterior chamber depth (ACD) was deeper with age and the severity of myopia, whereas the corneal curvature remained unchanged. The lens thickness became thinner from age 7 to 13, then it became thicker with age and the severity of myopia after age 15. The prevalence and degree of myopia in girls was more severe than in boys., Conclusions: The prevalence of myopia in Taiwan increased year by year. The increase in severity and prevalence of high myopia may be due to earlier onset.

This is the first report in the literature of the application of a laser flare-cell meter to examine the functional status of the blood-aqueous barrier in a patient with crystalline retinopathy. The patient, a 34-year-old man with typical crystalline retinopathy, had crystal deposits scattered throughout the posterior pole of the fundus in both eyes. Fluorescein angiography showed atrophy of the retinal pigment epithelium and geographic areas of choriocapillaris atrophy in the posterior pole. Electroretinography showed subnormal amplitude, and the light-peak/dark-trough ratio of the electrooculogram was reduced. Laser photometry showed an increase in the aqueous flare intensity in both eyes, compared with normal values obtained from healthy control subjects. The increase in the aqueous flare intensity in this patient indicates that the function of the blood-aqueous barrier might have been affected in crystalline retinopathy.

Oncocytic tumors of the lacrimal sac are very rare, with only 21 cases documented in the world literature. The authors report a 75-year-old woman who sought treatment for recurrent dacryocystitis and a palpable mass in the left medial canthal area. The patient underwent surgery for removal of a suspected lacrimal sac cancer, but pathologic findings indicated benign oncocytic adenomatous hyperplasia. Complete removal of the tumor and long-term follow-up are necessary in patients with lacrimal sac oncocytic lesions. The authors discuss the characteristic features of ocular adnexal oncocytic lesions and review the literature.

Extramedullary relapse of acute leukemia in sites outside the central nervous system or testes is rare. We report two children who developed proptosis due to an orbital mass as the initial presentation of leukemic relapse. The first patient was an 11-year-old girl with acute myelogenous leukemia who had undergone bone marrow transplantation 4 years previously. She had been in remission until 2 months prior to the present admission, when she developed isolated relapse of disease in the left orbit. The second patient, an 11-year-old girl with acute lymphoblastic leukemia, had been off chemotherapy for 2 years and in remission for 5 years. She suffered from concurrent orbital and central nervous system relapse. Both patients were treated with systemic chemotherapy and orbital radiotherapy. More than 1 year after the relapse, the proptosis was completely cured in both patients.

Purpose: To observe the effect of intraoperative mitomycin C on the size of the osteotomy site after dacryocystorhinostomy.:, Methods: A total of 15 eyes of 14 patients diagnosed with primary acquired nasolacrimal duct obstruction were assigned randomly to either a mitomycin C group or a control group. The surgical procedures in both groups were exactly the same, except that in the patients in the mitomycin C group, a piece of neurosurgical cottonoid soaked with 0.2 mg/ml mitomycin C was applied to the osteotomy site and then after 30 minutes was removed transnasally. Nasoendoscopic findings were recorded at the completion of the surgery and at 1 month, 3 months, and 6 months after surgery for the two groups. A computer-aided digitizer was used to calculate the surface area of the osteotomy site, and a Student's t test was used to compare the difference between the two groups., Results: All patients in the mitomycin C group remained symptom free after removal of their silicone tube (100% success), and there was one patient in the control group who had recurrent epiphora (87.5% success). Septo-osteotomy adhesion was found in two patients in the control group (25%), but there was no such adhesion found in the patients in the mitomycin C group. In the mitomycin C group, the average final surface area of the osteotomy at the end of the sixth postoperative month was 27.10 +/- 5.78 mm2, whereas that of the control group was only 10.83 +/- 3.37 mm2. Although the immediate postoperative surface area of the osteotomy showed no significant difference between the two groups, a statistically significant difference was noted at 6 months., Conclusion: Intraoperative mitomycin C is effective in maintaining a larger osteotomy size. This modification may possibly improve success rates over the traditional dacryocystorhinostomy procedure.

A four-staged operation is currently the most effective treatment available in the management of stable Graves' ophthalmopathy. This report describes the results of four-staged therapy in 51 patients with Graves' ophthalmopathy. Stage I, orbital decompression: 58 orbits in 32 patients underwent orbital decompression, with an average retroplacement effect of 4.2 +/- 2.2 mm (mean +/- SD). This procedure is effective to restore vision and correct the proptosis due to Graves' ophthalmopathy. Careful intraoperative titration of the retroplacement effect during orbital decompression is very important to achieve successful results. Stage II, strabismus surgery: 24 patients underwent strabismus surgery, including 11 with previous decompression surgery and six with previous simultaneous decompression and strabismus surgery. The overall success rate was 87% and previous decompression or strabismus surgery had no influence on the final results. Stage III, fissure width adjustment: 28 patients (45 eyes) received fissure width adjustment. Various procedures were performed and we found Müllerectomy with levator muscle stripping to be the most useful procedure for fissure width adjustment. The average improvement of fissure height was 3.1 +/- 1.8 mm. The rate of overall satisfactory results was 89%. There were five patients who received Staged IV cosmetic procedures with satisfactory results. Graves' ophthalmopathy is a chronic disease that needs thorough cooperation between doctor and patient. Careful evaluation of clinical parameters and individualized surgical goals are the keys to success.

Purpose: Myopic progression has been noted, especially during the period of puberty. It is interesting to investigate whether myopia will progress after the age of puberty and at what rate the changes in ocular components occur during its progression., Methods: A 5-year longitudinal study was made of refraction and its components among 345 National Taiwan University medical students (690 eyes). The examinations included corneal curvature and cycloplegic refraction measured by auto-refractor and retinoscopy, and axial length measurement with A scan ultrasonography. The same procedures and instruments were used again after 5 years., Results: The myopic prevalence increased from 92.8 to 95.8%; 21 new cases of myopia developed in the 5 years. The mean refractive error significantly increased from -4.26 +/- 2.66 D of freshmen to -4.94 +/- 2.70 D of clerks. The change in refractive error at the 5-year follow-up was 0.70 +/- 0.65 D more myopic for males and 0.54 +/- 0.64 D for females. The main change in the ocular components was in axial length, which increased from 25.54 to 26.05 mm in males and from 24.60 to 24.95 mm in females. Other optical components-including corneal curvature, anterior chamber depth, lens thickness-all remained relatively unchanged from the initial values., Conclusions: Myopia can progress after the age of puberty, but at a slower rate than during childhood. Axial elongation of the eyeball is the main component that changes in myopic progression.

Aims: To further understand the morphological and functional recovery of corneal epithelium following excimer laser photorefractive keratectomy (PRK)., Methods: The right eyes (group 1) of 15 male, New Zealand white rabbits weighing 2-3 kg underwent PRK. The left eye of each rabbit (group 2) underwent simple mechanical de-epithelialisation and were examined as treated controls. Both eyes of another eight rabbits (group 3) served as untreated controls. All eyes underwent a corneal epithelial permeability study by fluorophotometry at 2, 4, and 8 weeks after surgery. Five animals in groups 1 and 2 were sacrificed at 9, 10, and 12 weeks after surgery. The animals in group 3 were sacrificed at the end of the 12 week experimental period. Both eyes of each sacrificed animal were enucleated immediately and processed for both haematoxylin and eosin stain and electron microscopic study. The electron micrograph was magnified to 14,000x and the extent of hemidesmosome formation was quantified and analysed., Results: The corneal epithelial barrier to sodium fluorescein was subnormal and returned to a normal barrier state 4 weeks after PRK in group 1 whereas it was normal in group 2 throughout the examination period. The extent of hemidesmosome formation was abundant yet subnormal in both groups 1 and 2 up to 12 weeks, when compared with that in group 3., Conclusion: The corneal epithelium regained its functional barrier 4 weeks after PRK in rabbits while the extent of hemidesmosome formation was still subnormal 12 weeks after mechanical de-epithelialisation, with or without PRK.

Background and Objective: To evaluate the advantages of tissue glue application for the anastomosis of silicone intubation in congenital nasolacrimal duct obstruction., Patients and Methods: Patients with congenital nasolacrimal duct obstruction were treated with silicone intubation with the aid of tissue glue for end-to-end anastomosis. The recurrence rate, complications, and the need for general anesthesia at tube removal were recorded., Results: The silicone tubes for all 18 eyes studied were removed smoothly on an outpatient basis. Early extrusion was noted in 3 eyes. No recurrence of epiphora was noted in any eye after more than 6 months of follow-up., Conclusion: Tissue glue anastomosis is a beneficial modification that avoids the need for general anesthesia during stent removal in children and allows removal to be easily performed in an outpatient clinic.

Functional disorder of the blood-ocular barrier has been suggested in cases of degenerative high myopia. Whether the blood-aqueous barrier among young high myopes with healthy vitreous suffers changes is worthy to be explored. Flare density was measured with the laser flare cell meter (Kowa) in highly myopic and anisometropic students. The mean flare density of highly myopic eyes in the myopic group (4.28 +/- 1.13 photon counts/ms) was similar to that of the emmetropic control group (4.24 +/- 1.79 photon counts/ms). Moreover, the difference in flare density between the two eyes of anisometropic patients was not statistically significant. Thus, the blood-aqueous barrier seems intact in young high myopes with healthy posterior vitreous and fundus.

Visual-training methods in management of myopia are suggested as possibly leading to normal vision or an improvement in the refractive state. The purpose of this work was to investigate the hypothesis that a Qi-Qong ocular exercise improves visual function by training the accommodation bias. Variations of pupil size, accommodative amplitude, latency and speed of accommodative response and accommodative adaptation were evaluated objectively. The accommodative state was monitored with an objective infrared refractometer (Nidek AA-2000). Subjects were divided into two groups: experimental (n = 9), and control (n = 8). Subjects of the experimental group undertook the Qi-Qong ocular exercise for at least three years, and were able to perform the exercise smoothly and gently. Subjects of the control group had no knowledge of the Qi-Qong ocular exercise, but were given the same testing procedures as the experimental group. Results showed that Qi-Qong ocular exercise can improve the accommodative amplitude and accelerate the accommodative response slightly, but there was no effect on the latency of accommodative response. Furthermore, the level of accommodative adaptation was elevated, and the pupil became slight miotic. Therefore, the mechanism of visual improvement may undergo a great accommodative adaptation and produce a pinhole effect by miosis of the pupil. Methods of visual training can produce a false image of visual improvement from an enhanced parasympathetic response to a task, but this effect may be a factor that induces progression of myopia.

Patients with various stages of crystalline retinopathy were examined with vitreous fluorophotometry and the results were compared with those of normal subjects. Two patients with glistening crystals without pigment clumps, together with atrophy of the retinal pigment epithelium in the posterior pole, showed a normal inward permeability of fluorescein. Three patients with a large area of choriocapillaris atrophy in the posterior pole, in addition to atrophy of retinal pigment epithelium, demonstrated an increase in the rate of inward fluorescein penetration. Three patients with extensive areas of choriocapillaris atrophy throughout the fundus also revealed an increased posterior vitreous penetration ratio.

Astigmatism has been suggested to be an important factor in the production and/or progression of myopia. Chickens have been used as a myopic animal model for several years. In the present investigation our aim was to evaluate the importance of surgically induced corneal astigmatism by peripheral corneal incision with compression suture in one eye, the right, of 3-day-old chicks. Vertical incision (2 mm) with compression suture (nylon 9-0, one stitch) induces against-the-rule astigmatism, horizontal incision with compression induces with-the-rule astigmatism. Four groups were studied 1) with one vertical cut, 2) one horizontal cut, 3) two vertical cuts, 4) two horizontal cuts. The eyes were measured by caliper after 8 weeks. Eye enlargements were induced in all groups, however, less by one cut (astigmatism around 5 diopters) than by two cuts (astigmatism 10 diopters, or more). In the latter groups the pattern of equatorial eye enlargement depended on the axis of the induced astigmatism, the greater elongation being associated with the strongest refracting corneal meridian. All considered, the results suggest that significant corneal astigmatism could be another factor in the production of myopia, possibly acting by way of optical degradation of retinal image quality.

Inferomedial orbital decompression was done on 26 eyes with dysthyroid optic neuropathy (DON), seven eyes with corneal exposure which had not responded to topical lubricants, and six with disfiguring exophthalmos. Twenty-one of the 26 DON eyes (80.7%) had visual acuity improvement equal to or greater than two lines by the Snellen chart, and there was only one in all 39 eyes that dropped more than two lines. The average retinal sensitivity improvement was of borderline significance (4.25 +/- 5.73 dB), but for those 13 severely affected eyes (preoperative sensitivity loss > or = 10 dB), 11 (84.6%) of them showed significant improvement. There were 16 bilateral and seven unilateral cases. Out of all 39 eyes, the average retroplacement effect was 4.6 +/- 2.3 mm, and none of them had postoperative asymmetry greater than 2 mm by Hertel's exophthalmometry. Although the palpebral fissure height tends to remain the same after surgery, upper lid retraction is likely to be worse. The most frequent sequela was diplopia, which tended to occur in more severely myopathic eyes regardless of the surgical approach used. Although a staged approach is mandatory in surgical treatment of this disorder, individualization of surgical goals and intraoperative titration of the retroplacement effect are of equal importance for optimal results.

Choroideremia is a bilateral and progressive chorioretinal degenerative disease of X-linked inheritance. In Taiwan, the disease has rarely been reported. We recently found 8 male patients and 5 female carriers in two Chinese families with choroideremia and studied the clinical, psychophysical and electrophysiological properties of the disease. All patients revealed characteristic fundus and fluorescein angiographic changes in retinal pigment epithelium, and choroidal atrophy of variable extent. The severity of the functional impairments paralleled the fundus changes and the patients' age. However dark adaptation and the visual field were affected earlier than visual acuity and color sensation. In addition, rod cell impairment was found to be more severe than cone cell impairment in the electroretinographic studies. On the other hand, all carriers revealed similar diffuse punctate pigmentary changes and only mild abnormalities in dark adaptation. These findings may suggest that in choroideremia patients the photoreceptor cells are very sensitive to the influence of the choroidal atrophy, and that rod cells may be even more vulnerable than cone cells.

To elucidate the pathophysiologic features of conjunctival concretions, we performed polarized microscopic examinations, immunocytochemical studies, histochemical stains, and electron microscopic studies of concretions obtained from five patients with chronic conjunctivitis. Electron-dense secretory granules, ranging from 0.2 to 0.5 micron in diameter and stained positively for periodic acid-Schiff and mucicarmine, were found in the superficial lining epithelial cells of the pseudogland of Henle. In view of the granular and membranous figures reflecting degenerating epithelial cells and secretory granules in the concretions, we argue that the concretions, are mostly composed of the mucinous secretion of the transformed conjunctival glands admixed with the degenerative products of the epithelial cells.

Cytomegalovirus retinitis is an opportunistic and vision-threatening disease in immunosuppressed patients. Currently available antiviral agents have been unsuccessful in halting its progression. We report a case of cytomegalovirus retinitis which occurred 6 months after renal transplantation and was successfully treated with an investigational drug, ganciclovir (DHPG [Dihydroxy propoxymethyl guanine], Cytovene, BW-B759U), via intravenous administration, with resolution of active retinal lesions and the cessation of cytomegalovirus shedding in the urine. There was neither a recurrence of cytomegalovirus retinitis nor an occurrence of retinal detachment during the 9-month follow-up after intravenous ganciclovir therapy.

Retinoblastoma (Rb) occurs in two different genetic forms, hereditary and nonhereditary. Patients with nonhereditary Rb have unilateral, unifocal tumors, and those with the hereditary form usually have bilateral, multiple tumors. However, about 15% of patients with unilateral disease actually have multifocal tumors due to the hereditary form of Rb. Distinction between unilateral hereditary and sporadic Rb is very important both to the patient, who is at risk of later development of other malignancies, and to any future siblings and offspring. With only clinical data, the discrimination may be difficult. The cytogenetic detection of multiple unrelated clones in the tumor is very helpful for differential diagnosis because this finding strongly suggests the presence of a prezygotic germ cell mutation, which is heritable. A 23-month-old Chinese boy was found to have a single retinoblastoma at the right eye. Cytogenetic study of the tumor cells revealed three abnormal clones. Two of them were related, but the third one had completely different markers, suggesting a hereditary, multifocal origin of the tumor. None of the three clones showed an abnormality of 13q, which is present in about 21% of all Rb patients.