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Background: To demonstrate the morphological characteristics of Bergmeister papilla (BMP), a persistent hyaloid remnant tissue, and its effects on the measurements and repeatability of spectral domain optical coherence tomography (OCT). Methods: A prospective cross-sectional study was used to collect 83 patients with BMP and 76 age-matched unaffected individuals from a tertiary care institution. Imaging including 5-line raster and 3 consecutive optic disc cube scans centered on the optic disc were acquired using the Cirrus HD-OCT. Structural characteristics of BMP were classified according to the images of raster scans, and the repeatability of optic nerve head and retinal nerve fiber layer parameters was analyzed by calculating the test-retest standard deviation, coefficient of variance, and intraclass correlation coefficient. Results: BMP was categorized into lifting edge (LE) type where does not cover the entire optic nerve head, but partially covers the corners, and covering disc (CD) type in which covers the entire cupping area like a cap. Among the BMP of 83 eyes, 58 (63.9%) were lifting edge type and 33 (36.1%) were CD type, and some of the optic nerve head parameters in OCT showed significant differences between the CD and LE types and normal control eyes. The analysis of repeatability showed that eyes with LE types affected cup volume and nasal retinal nerve fiber layer parameters and correlated with BMP location. Conclusion: Because BMP might be a pitfall in OCT imaging, it is necessary to be careful when interpreting OCT in an eye with BMP.

Purpose Recent studies indicate that microRNAs (miRNAs) play essential roles in cellular development, homeostasis, and response. However, the function of miRNA in the senescence of human lymphatic endothelial cells (HLECs) remains unclear. We aimed to find miRNAs related to HLECs’ aging and elucidate miRNAs’ molecular mechanism. Methods HLECs were cultured, and total RNA was harvested from the cells. Then, MiRNA screening was performed, with targeted miRNAs selected using quantitative polymerase chain reaction (qPCR). To evaluate the effect of miR-193b, HLECs were treated with a mimic and inhibitor, and tube formation was investigated. We used a luciferase assay to analyze the expression of CCND1, a well-known gene involved in cell passage, in response to miR-193b. Results Seven miRNAs were primarily screened. Among them, miR-193b-3p showed a high affinity for HLECs. Transfection of the mir-193b-3p mimic decreased cell proliferation and affected tube formation. CCND1 mRNA and protein levels also were decreased by the cell-transfected mir-193b-3p mimic. Conclusion This study provides the first evidence that miR-193b-3p represses cell proliferation and regulates CCND1, which may play an important role in lymphangiogenesis.

Purpose: This study aimed to investigate the surgical outcomes of nonadjustable Harada-Ito surgery under general anesthesia.Methods: Twenty-two patients who underwent nonadjustable modified Harada-Ito surgery under general anesthesia were reviewed retrospectively. Among them, 21 out of the 22 patients who were followed up for 6 months after surgery were included in this study. Subjective cyclotorsion (double Maddox rod test) and objective cyclotorsions (fundus photography) were measured. Success of the surgery was defined as follows: success (the patients do not acknowledge diplopia at any direction), partial (the patients feel diplopia at a specific direction, but they do not feel discomfort in routine life), and fail (the patients feel diplopia in primary gaze, hence requiring a thorough investigation).Results: The mean age of the patients (18 male and 3 female) was 56.5 years (range, 40–77 years). Based on the alternate prism cover test, the patients had 4.2 ± 3.0 prism diopters of vertical deviation. The corrected amounts of cyclotorsion based on the double Maddox rod test and fundus photography were 14.8° ± 7.5° and 9.8° ± 7.9°, respectively, and were significantly different between the two methods (p = 0.006). After the surgery, 20 out of the 21 patients (95.2%) completely recovered from diplopia in the primary gaze. However, among the 20 patients, seven complained of diplopia in the secondary gaze (down gaze, four patients; head tilt gaze, three patients). The success group had a smaller preoperative subjective excyclotorsion than the partial and fail groups (12.6° ± 2.5° and 21.0° ± 8.9°, respectively; p = 0.046).Conclusions: Nonadjustable modified Harada-Ito surgery under general anesthesia has favorable success rate, and preoperative subjective excyclotorsion can be a prognostic factor in patients with bilateral superior oblique palsy.

Purpose: To investigate physical ophthalmological parameters relevant to job choice.Methods: I analyzed the ophthalmological demands imposed on those engaged in military service and on applicants for army officer, air force officer, naval officer, railroad officer, firefighting officer, police officer, state public officer, and pilot positions; the visual requirements for a driver’s license were also examined. Visual dysfunction was classified into loss of visual acuity, visual field defects, refractive errors, color vision disorders, strabismus, and other disorders. Additional restrictions imposed by each occupation were investigated.Results: Various standards were imposed on the occupational groups. Applicants to the Air Force Academy required 1.0 visual acuity; the visual acuity for applicants to the military and naval academies were ≥0.6, and those for fire and police personnel ≥0.8. The general public official regulations do not mention visual acuity. In terms of visual field defects, such defects must be

Background: To develop the normative data of the Korean version of the MNREAD acuity chart.Methods: A Korean version was prepared based on the MNREAD acuity chart developed by Gordon Legge of the University of Minnesota, USA. A linguist selected the representative 80 sentences composed of 9 words at the level of the 2nd and 3rd grades of elementary school. Reading abilities were measured for 20-35 years old with normal visual acuity (corrected visual acuity of 1.0 or better) for 80 sentences. Among 80 sentences, 38 items with a similar speed were prepared for the right and left eyes of the Korean version according to the format of the MNREAD acuity chart. Reading speed (word per minute, wpm) for healthy participants, the reading acuity (the smallest detectable font size), and the critical print size (the smallest font size without reduction of reading speed) were analyzed.Results: The average age of the experimental group was 28.3 ± 2.6 years (male: female 4=16). The average reading speed for 38 sentences was 3.66 ± 0.69 seconds, and there was no difference in the average reading speed between sentences (p=0.836). The reading speed was 146.2 wpm for the right eye and 142.5 wpm for the left eye in logMAR 1.0 size, and 97.7 wpm and 99.7 wpm in logMAR 0.0 size. Reading acuity was measured as logMAR 0.0 or better in 80% of cases. All subjects showed a critical print size of 0.2 or better logMAR.Conclusion: Using the Korean version of the MNREAD acuity chart, the reading ability including reading acuity, reading speed and critical print size, can be measured. It is thought that it will be a useful tool to measure reading ability even for those who speak Korean as their native language.

To describe clinical manifestations and short-term prognosis of ocular motility disorders following coronavirus disease-2019 (COVID-19) vaccination.Ocular motility disorders were diagnosed by clinical assessment, high-resolution magnetic resonance imaging, and laboratory testing. Clinical manifestations, short-term prognosis, and rate of complete recovery were analyzed.Sixty-three patients (37 males, 26 females) with a mean age of 61.6 ± 13.3 years (range, 22-81 years) were included in this study. Among 61 applicable patients with sufficient information regarding medical histories, 38 (62.3%) had one or more significant underlying past medical histories including vasculopathic risk factors. The interval between initial symptoms and vaccination was 8.6 ± 8.2 (range, 0-28) days. Forty-two (66.7%), 14 (22.2%), and 7 (11.1%) patients developed symptoms after the first, second, and third vaccinations, respectively. One case of internuclear ophthalmoplegia, 52 cases of cranial nerve palsy, two cases of myasthenia gravis, six cases of orbital diseases (such as myositis, thyroid eye disease, and IgG-related orbital myopathy), and two cases of comitant vertical strabismus with acute onset diplopia were found. Among 42 patients with follow-up data (duration: 62.1 ± 40.3 days), complete improvement, partial improvement, no improvement, and exacerbation were shown in 20, 15, 3, and 4 patients, respectively.This study provided various clinical features of ocular motility disorders following COVID-19 vaccination. The majority of cases had a mild clinical course while some cases showed a progressive nature. Close follow-up and further studies are needed to elucidate the underlying mechanisms and long-term prognosis.

To investigate the current status of electrophysiological test use in ophthalmology.We analyzed 1057 electrophysiological tests conducted at Kim's Eye Hospital from January 1 to December 31, 2018. The included tests were electroretinogram (full-field, multifocal, and pattern ERG), electrooculogram (EOG), and visual evoked potential (pattern and flash VEP). To investigate the distribution of use of subspecialties, it was divided by subspecialties (retina, glaucoma, oculoplastic surgery, pediatric ophthalmology, neuro-ophthalmology, cornea, and external diseases).The patients were aged 50.6 years on average and included 624 men and 433 women. Among the electrophysiological tests, VEP was the most common, with 567 cases (53.6%), followed by ERG with 311 cases (29.4%) and EOG with 98 cases (9.3%). Regarding the purpose of use, the objective of visual function evaluation was the highest at 56.3%, followed by the differential diagnosis of unknown causes (33.0%) and the confirmation of diagnoses (10.7%). Both VEP and ERG were used the most for visual function evaluation, and mfERG was most used for differential diagnosis of unknown etiology. Electrophysiological tests were most often used in the retina department, but VEPs were used in various fields such as neuro-ophthalmology, glaucoma, and oculoplastics.Electrophysiological tests are used to objectively evaluate visual function or discriminate diseases of unknown causes and are used in various departments. Electrophysiology testing is expected to be an additional test to assess visual function.

Background This study is to evaluate the accuracy of machine learning for differentiation between optic neuropathies, pseudopapilledema (PPE) and normals. Methods Two hundred and ninety-five images of optic neuropathies, 295 images of PPE, and 779 control images were used. Pseudopapilledema was defined as follows: cases with elevated optic nerve head and blurred disc margin, with normal visual acuity (> 0.8 Snellen visual acuity), visual field, color vision, and pupillary reflex. The optic neuropathy group included cases of ischemic optic neuropathy (177), optic neuritis (48), diabetic optic neuropathy (17), papilledema (22), and retinal disorders (31). We compared four machine learning classifiers (our model, GoogleNet Inception v3, 19-layer Very Deep Convolution Network from Visual Geometry group (VGG), and 50-layer Deep Residual Learning (ResNet)). Accuracy and area under receiver operating characteristic curve (AUROC) were analyzed. Results The accuracy of machine learning classifiers ranged from 95.89 to 98.63% (our model: 95.89%, Inception V3: 96.45%, ResNet: 98.63%, and VGG: 96.80%). A high AUROC score was noted in both ResNet and VGG (0.999). Conclusions Machine learning techniques can be combined with fundus photography as an effective approach to distinguish between PPE and elevated optic disc associated with optic neuropathies.

Purpose: To investigate the factors for treatment success in anisometropic amblyopia according to the spherical equivalent (SE) type of amblyopic eyes. Methods: Medical records of 397 children with anisometropic amblyopia aged 3 to 12 years during 2010~2016 were retrospectively reviewed. Anisometropia was defined as ≥1 diopter (D) difference in SE, or ≥1.5 D difference of cylindrical error between the eyes. According to the SE of amblyopic eyes, patients were categorized into hyperopia (SE ≥1D), emmetropia (-1< SE

Pathogenic NR2F1 variants cause a rare autosomal dominant neurodevelopmental disorder referred to as the Bosch–Boonstra–Schaaf Optic Atrophy Syndrome. Although visual loss is a prominent feature seen in affected individuals, the molecular and cellular mechanisms contributing to visual impairment are still poorly characterized. We conducted a deep phenotyping study on a cohort of 22 individuals carrying pathogenic NR2F1 variants to document the neurodevelopmental and ophthalmological manifestations, in particular the structural and functional changes within the retina and the optic nerve, which have not been detailed previously. The visual impairment became apparent in early childhood with small and/or tilted hypoplastic optic nerves observed in 10 cases. High-resolution optical coherence tomography imaging confirmed significant loss of retinal ganglion cells with thinning of the ganglion cell layer, consistent with electrophysiological evidence of retinal ganglion cells dysfunction. Interestingly, for those individuals with available longitudinal ophthalmological data, there was no significant deterioration in visual function during the period of follow-up. Diffusion tensor imaging tractography studies showed defective connections and disorganization of the extracortical visual pathways. To further investigate how pathogenic NR2F1 variants impact on retinal and optic nerve development, we took advantage of an Nr2f1 mutant mouse disease model. Abnormal retinogenesis in early stages of development was observed in Nr2f1 mutant mice with decreased retinal ganglion cell density and disruption of retinal ganglion cell axonal guidance from the neural retina into the optic stalk, accounting for the development of optic nerve hypoplasia. The mutant mice showed significantly reduced visual acuity based on electrophysiological parameters with marked conduction delay and decreased amplitude of the recordings in the superficial layers of the visual cortex. The clinical observations in our study cohort, supported by the mouse data, suggest an early neurodevelopmental origin for the retinal and optic nerve head defects caused by NR2F1 pathogenic variants, resulting in congenital vision loss that seems to be non-progressive. We propose NR2F1 as a major gene that orchestrates early retinal and optic nerve head development, playing a key role in the maturation of the visual system., Jurkute et al. expands the phenotypic spectrum of pathogenic NR2F1 variants, providing a detailed characterization of the retinal and optic nerve changes with high-resolution optical coherence tomography imaging. Data from a mutant mouse model confirms the key role played by NR2F1 in directing retinogenesis and the development of the optic nerve head., Graphical Abstract Graphical Abstract

International audience; Dominant optic atrophy (DOA) is an inherited mitochondrial disease leading to specific degeneration of retinal ganglion cells (RGCs), thus compromising transmission of visual information from the retina to the brain. Usually, DOA starts during childhood and evolves to poor vision or legal blindness, affecting the central vision, whilst sparing the peripheral visual field. In 20% of cases, DOA presents as syndromic disorder, with secondary symptoms affecting neuronal and muscular functions. Twenty years ago, we demonstrated that heterozygous mutations in OPA1 are the most frequent molecular cause of DOA. Since then, variants in additional genes, whose functions in many instances converge with those of OPA1, have been identified by next generation sequencing. OPA1 encodes a dynamin-related GTPase imported into mitochondria and located to the inner membrane and intermembrane space. The many OPA1 isoforms, resulting from alternative splicing of three exons, form complex homopolymers that structure mitochondrial cristae, and contribute to fusion of the outer membrane, thus shaping the whole mitochondrial network. Moreover, OPA1 is required for oxidative phosphorylation, maintenance of mitochondrial genome, calcium homeostasis and regulation of apoptosis, thus making OPA1 the Swiss army-knife of mitochondria. Understanding DOA pathophysiology requires the understanding of RGC peculiarities with respect to OPA1 functions. Besides the tremendous energy requirements of RGCs to relay visual information from the eye to the brain, these neurons present unique features related to their differential environments in the retina, and to the anatomical transition occurring at the lamina cribrosa, which parallel major adaptations of mitochondrial physiology and shape, in the pre- and post-laminar segments of the optic nerve. Three DOA mouse models, with different Opa1 mutations, have been generated to study intrinsic mechanisms responsible for RGC degeneration, and these have further revealed secondary symptoms related to mitochondrial dysfunctions, mirroring the more severe syndromic phenotypes seen in a subgroup of patients. Metabolomics analyses of cells, mouse organs and patient plasma mutated for OPA1 revealed new unexpected pathophysiological mechanisms related to mitochondrial dysfunction, and biomarkers correlated quantitatively to the severity of the disease. Here, we review and synthesize these data, and propose different approaches for embracing possible therapies to fulfil the unmet clinical needs of this disease, and provide hope to affected DOA patients.

Purpose The aim of this study was to investigate the quantitative effect of inferior oblique (IO) 10- and 14-mm recession on postoperative horizontal deviation. Methods Patients (22 men and 18 women) who underwent IO recession were divided into two groups for comparison studies: group 1 (10-mm IO recession, 15 patients) and group 2 (14-mm IO recession, 25 patients). Preoperative and postoperative horizontal deviations were measured, and the resulting horizontal deviations from the 10- and 14-mm IO recession surgeries were compared. The effects of superior oblique underaction, IO overaction, and combined exodeviation on postoperative horizontal deviation were analyzed. Results Although group 1 did not show a significant horizontal deviation change after surgery (1.9 ± 4.5 prism diopters [PD], p = 0.452), group 2 had a meaningful horizontal change after 14-mm recession (2.2 ± 3.8 PD, p = 0.022). Both groups showed a significant esodrift in horizontal deviation (group 1, p = 0.017; group 2, p = 0.030) in patients with exodeviation over 8 PD. The mean change in horizontal deviation was 6.0 ± 5.4 PD for group 1 and 9.0 ± 5.0 PD for group 2. Although the amount of superior oblique underaction did not affect the extent of change in horizontal deviation, patients with severe IO overaction showed a significant change in horizontal deviation after 14-mm IO recession. Conclusions Fourteen-millimeter IO recession could make a statistically significant change in horizontal deviation after surgery. In addition, esodrift should be considered after IO recession in patients with a preoperative exodeviation greater than 8 PD or severe IO overaction.

Purpose: To evaluate the response to corticosteroid therapy as a primary treatment for ocular myasthenia gravis. Methods: Patients diagnosed as having ocular myasthenia gravis by an acetylcholine receptor binding antibody test between January 2011 and September 2015 were included in the study and started receiving treatment with a corticosteroid. Patients with a blowout fracture, hyperthyroidism, diabetes mellitus, hypertension, cardiovascular disease, or history of strabismus surgery were excluded. Disappearance of diplopia and ptosis were considered a response to treatment. Results: Methylprednisolone therapy was administered to 29 patients (19 men and 10 women; average age: 49 ± 16.5 years) as an initial treatment. A total of 6 patients were lost to follow-up. Twenty-three of 29 patients (82.6%) were regarded as having presented a response to treatment. The average treatment duration was 3 weeks for patients responding to primary treatment. Eight patients complained of adverse effects from steroid therapy such as heartburn, insomnia, weight gain, and myalgia. Conclusions: A corticosteroid could be considered as an initial treatment for patients diagnosed as having ocular myasthenia gravis by an acetylcholine receptor binding antibody test. [ J Pediatr Ophthalmol Strabismus . 2018;55(5):339-342.]

To investigate the reliability of FDT and 24-2 and 30-2 Humphrey perimetry in children.We retrospectively reviewed the records corresponding to 274 eyes of children aged 6-12 years, who underwent FDT and 30-2 and 24-2 Humphrey visual field testing from January 2011 through March 2013. Each test group was divided into two subgroups: a normal visual acuity subgroup (0.8 Snellen, group 1) and a low visual acuity subgroup (≤0.8 Snellen, group 2). Reliability indexes such as fixation losses, test duration, and the number and rate of false-positive errors were analyzed.In both subgroups, test duration was shortest for 24-2 perimetry (group 1: p0.0001; group 2: p0.0001). FDT was associated with lower rates of fixation loss, false positive errors, and false negative errors than 30-2 perimetry. However, the fixation loss rate of FDT was only significantly lower under the subgroup analysis. The normal visual acuity subgroup had a higher MD score on FDT vs. 30-2 perimetry (P = 0.028). However, the PSD was similar for all tests.This reliability study showed that FDT perimetry is superior to 30-2 SITA perimetry. There was no significant difference in the reliability indexes for FDT and 24-2 SITA perimetry; thus, when considering test duration and reliability, 24-2 SITA perimetry appears to be the optimal choice in pediatric patients.

Leber hereditary optic neuropathy (LHON) is an important cause of mitochondrial blindness. The majority of patients harbor one of three mitochondrial DNA (mtDNA) point mutations, m.3460G>A, m.11778G>A, and m.14484T>C, which all affect complex I subunits of the mitochondrial respiratory chain. The loss of retinal ganglion cells in LHON is thought to arise from a combination of impaired mitochondrial oxidative phosphorylation resulting in decreased adenosine triphosphate (ATP) production and increased levels of reactive oxygen species. Treatment options for LHON remain limited, but major advances in mitochondrial neuroprotection, gene therapy, and the prevention of transmission of pathogenic mtDNA mutations will hopefully translate into tangible benefits for patients affected by this condition and their families.

Purpose: To evaluate and compare surgical outcomes with respect to refractive errors in strabismus surgery for the treatment of intermittent exotropia (IXT).The medical records of patients with IXT who were treated by one surgeon from January 2005 and June 2011 were reviewed. Three hundred and thirty-three IXT patients were included and divided into three groups according to preoperative refractive error: IXT with hyperopia (group I), IXT with emmetropia (group II), and IXT with myopia (group III). The surgical outcomes with respect to sensory and motor criteria were compared among the three groups.The surgical success rates according to motor criteria and sensory and motor criteria combined were higher in groups I (29 patients) and III (124 patients) than in group II (180 patients) at postoperative 3 and 6 months and at the last follow-up. Stereopsis was significantly better in groups II and III than in group I preoperatively (P=0.002 by one-way analysis of variance test); however, the difference was not significant postoperatively. Twenty patients in group I (69.0%) were prescribed undercorrected hyperopic spectacles postoperatively, while only 22 patients in group III (17.7%) were prescribed spectacles with more myopic power than their refractive errors.In the surgical treatment of IXT, hyperopia was not an indicator of poor prognosis. Taking into consideration the age effect, follow-up period after IXT surgery, and stereopsis improvement, hyperopic refractive error is rather a good prognostic factor.

The main objectives of voluntary eye movements are either to position or maintain images of interest on the fovea, the small central retinal area of highest visual acuity. Saccades and smooth pursuit are controlled by different neural structures. These differing anatomical pathways include several cortical areas that mediate cognitive control of eye movements, in contrast to brainstem structures that are mainly concerned with the motor control of eye movements [1]. The analysis of eye movements has been shown to provide key contributions to the diagnosis of some neurodegenerative, hereditary, and metabolic disorders. Videonystagmography (VNG) was designed to acquire video images of eye movements, especially in nystagmus, and is potentially useful to clinicians in otorhinolaryngology, neurology, and ophthalmology [2]. Traditionally, electronystagmography (ENG), which relies on the corneo-retinal potential to record eye movements, is considered the gold standard for evaluating dizzy patients [3]. In contrast to ENG, VNG records eye movements using digital video image technology employing infrared illumination to determine eye position. The use of VNG enables simultaneous subjective observation of eye movements together with objective data collection and analysis of eye movement waveforms via computer algorithms. VNG has the benefit of not requiring skin preparation or electrode application and wiring. Moreover, adjustments are seldom required as VNG does not depend on changes in corneo-retinal potential over time in contrast to ENG. However, VNG is unable to record eye movements when the eyes are closed [4]. To date, there has been no study reporting normative data of saccade movements obtained from an Asian patient population, including Koreans. The aim of this study was to establish a set of normative data of saccade movements obtained from 25 healthy Korean adults using VNG (SLVNG; SLMED, Seoul, Korea) and to evaluate the effects of manual correction on this data.

PURPOSE We investigated chief complaints and ocular disorders in infants under one year of age and analyzed the association between complaints and disorders. METHODS The medical records of 815 infants were reviewed. Chief complaints were grouped into the following 11 categories: eyelid drooping, epiphora (tearing), ocular discharge, lid swelling, eyelashes touching the eyeball, abnormalities of the anterior segment, abnormal eyeball movement (e.g., squint or nystagmus), red eye, trauma, poor eye contact, and miscellaneous. We performed ophthalmologic examinations at the doctors' discretion and analyzed the relationship between chief complaint and final diagnosis. RESULTS Mean age of visiting the outpatient clinic was 6.09 ± 3.07 months. The most common complaint was ocular discharge, followed by abnormal eyeball movement, epiphora, and eye redness. Among infants with ocular discharge, most were attributed to congenital nasolacrimal duct obstruction (155 infants) and conjunctivitis (75 infants). A total of 160 guardians complained of abnormal eyeball movement and 86 of 160 infants (51.9%) suffered from pseudoesotropia. Additionally, exodeviation and esodeviation was found in 17.9% and 16.4% of infants, respectively. Eight guardian complained of poor eye contact in their infants and these infants were diagnosed with retinal disorders (3), congenital optic nerve disorders (2), cataract (1), glaucoma (1), and high hyperopia (1). CONCLUSIONS The most common ocular symptoms in infants under one year of age included ocular discharge, epiphora, and eye redness. However, infants with poor eye contact or suspected abnormal eye movement should undergo a full ophthalmologic examination.

To evaluate the prevalence of aquaporin 4 antibody (AQP4-Ab) in new-onset optic neuritis patients and investigate the characteristics of seropositive patients.Thirty-six women and six men with new-onset isolated optic neuritis were included in this study between January 2013 and December 2014. AQP4-Ab was detected and all blood samples were obtained prior to treatment and within one week from attack. The patients were sub-grouped into either a seropositive group or a seronegative group according to AQP4-Ab. Differences in age, gender, initial visual acuity, and final visual acuity between groups were analyzed.Six (14.3%) of these patients (five women and one man) exhibited AQP4-Ab. There was no significant difference in mean age between study groups (positive group: 38.7 ± 11.5 years, negative group: 42.3 ± 14.7 years, P=0.548). Bilateral simultaneous involvement was more common in seropositive patients than in seronegative patients (occurred in two out of six seropositive patients and in one out of 36 seronegative patients, P = 0.007). With regards to poor visual outcome (worse than 1.0 LogMAR), seropositive patients exhibited more severe visual loss than seronegative patients. None of the seropositive patients exhibited myelitis symptoms during the follow-up period (mean follow-up period: 8-32 months).The prevalence of AQP4 antibody was often detected in new-onset optic neuritis patients. In patients with bilateral involvement or poor initial visual acuity, the AQP4 antibody test should be considered.

Aim To screen microRNAs (miRNAs) and set up target miRNAs in pterygium. Methods Primary fibroblasts were isolated from pterygium and Tenon's capsule and cultured. Immunocytochemical analysis and Western blotting were performed to confirm the culture of fibroblasts. In all, 1733 miRNAs were screened in the first step by using GeneChip(®) miRNA3.0 Array. Specific miRNAs involved in the pathogenesis of pterygium were subsequently determined using the following criteria: 1) high reproducibility in a repetitive test; 2) base log value of >7.0 for both control and pterygial fibroblasts; and 3) log ratio of >1.0 between pterygial fibroblasts and control fibroblasts. Results Primary screening showed that 887/1733 miRNAs were up-regulated and 846/1733 miRNAs were down-regulated in pterygial fibroblasts compared with those in control fibroblasts. Of the 1733 miRNAs screened, 4 miRNAs, namely, miRNA-143a-3p, miRNA-181a-2-3p, miRNA-377-5p and miRNA-411a-5p, met the above-mentioned criteria. Primary screening showed that these 4 miRNAs were up-regulated in pterygial fibroblasts compared with control fibroblasts and that miRNA-143a-3p had the highest mean ratio compared with the miRNAs in control fibroblasts. Conclusion miRNA-143a-3p, miRNA-181a-2-3p, miRNA-377-5p and miRNA-411a-5p are up-regulated in pterygial fibroblasts compared with control fibroblasts, suggesting their involvement in the pathogenesis of pterygium.

Tissue plasminogen activator (tPA), an effective thrombolytic agent, is commercially available for the treatment of vitreous hemorrhage, subfoveal hemorrhage, suprachoroidal hemorrhage, and retinal vascular occlusive disease in the field of ophthalmology [1,2]. In particular, intravitreal or subretinal injections of tPA have been used when performing surgery for submacular hemorrhages or subfoveal choroidal neovascularization [3-8]. Dose-dependent retinal toxicity has been reported with the injection of intravitreal tPA; this toxicity has been reported to be due to the L-arginine vehicle rather than the tPA itself [9]. The retinal toxicity of L-arginine has been reported to increase nitric oxide (NO) in cells [10]. NO activates guanylate cyclase in the photoreceptor layer of the retina to produce more cyclic guanosine monophosphate (cyclic-GMP) [11]. In the rd/rd mouse, photoreceptor degeneration is due to a mutation of the rod-specific enzyme cyclic-GMP phosphodiesterase, resulting in permanently open cyclic-GMP-gated cation channels in the rod outer segment membrane, allowing Na+ and Ca2+ ions to enter the cell and leading to possibly toxic levels of Ca2+ [12]. Therefore, the increase in NO that is caused by L-arginine leads to the accumulation of cyclic-GMP, thus leading to toxicity. Amiloride has an inhibitory function on the Na+/H+ exchanger in the apical plasma membrane of the distal nephron and the cyclic-GMP gated channel of the outer membrane of retinal photoreceptor cells [13]. Therefore, inhibition of the cyclic-GMP gated channels of retinal cells may result in a decrease in intracellular Ca2+, which then leads to increased retinal cell survival after tPA-induced toxicity. The purpose of this study was to examine the effect of amiloride on cellular toxicity caused by tPA-arginine in mouse primary retinal cells.

To evaluate the psychosocial distress of part-time occlusion therapy in intermittent exotropia. A total of 25 children (15 males and 10 females, aged 3 to 7 years, mean age 4.7 years) with intermittent exotropia were enrolled. Behavioral and psychosocial problems were assessed by the Korean Child Behavior Checklist (K-CBCL), which consists of eight categories of withdrawal, somatic problems, depression/anxiety, social problems, thought problems, attention problems, delinquent behavior, and aggressive behavior, and the Amblyopia Treatment Index (ATI). The ATI was designed to evaluate the three factors of compliance, adverse effect, and social stigma. The Parenting Stress Index (PSI) is a parent self-report designed to identify potentially dysfunctional parent–child systems. The K-CBCL was obtained before and after occlusion therapy, and the ATI and PSI were taken from parents only after occlusion therapy. We evaluated the change on the K-CBCL and the correlation between the K-CBCL and ATI. The attention problem assessed by the K-CBCL significantly decreased after occlusion therapy. On the ATI, the social stigma was relatively lower than compliance and adverse effect factors (Likert scale 2.64, 3.11, and 3.11, respectively). The somatic problem assessed by the K-CBCL and compliance on the ATI were significantly correlated (p = 0.014). There was no significant change in percentile scores of each subscale (parental dominant scale and child dominant scale) of the PSI. Total stress index before and after occlusion therapy was 97.16 ± 8.38 and 97.00 ± 8.16 respectively (p = 0.382). Occlusion therapy may influence the psychosocial impact on intermittent exotropia patients. Part-time occlusion significantly decreased the attention problem in children with intermittent strabismus. Children with a high somatic problem score on the KCBCL showed poor compliance to the part-time occlusion.

A 32-year-old man with a pituitary tumor had bitemporal hemianopia (figure 1). Peripapillary retinal nerve fiber layer (RNFL) in optical coherence tomography (OCT) was reduced, which corresponded to visual field defects. OCT angiography showed a dropout of capillaries and correlated well with RNFL loss in the OCT (figure 2). Compressive optic neuropathy may be associated with loss of the retinal ganglion cell layer and impaired peripapillary retinal perfusion. OCT angiography may be helpful to detect various optic neuropathies and in analyzing the vascular status of the optic nerve head and RNFL.1

A 29-year-old man was referred to our institution for a visual function evaluation 14 months after a traffic accident. His best-corrected visual acuity was 1.0 in both eyes. Brain magnetic resonance imaging revealed multifocal encephalomalacic changes in the left frontal and left temporal cortical and subcortical regions. Focal encephalomalacic changes in the left basal ganglia were observed in association with passive dilation of the left lateral ventricle, due to the presence of old haemorrhage. A non-specific scattered scotoma was found in the left eye. Spectral-domain optical coherence tomography (SD-OCT) was performed and peripapillary retinal nerve fibre layer (RNFL) thickness was reduced in the superotemporal and inferotemporal quadrants of the ipsilateral eye and the temporal and superonasal quadrants in the contralateral eye. SD-OCT revealed retinal ganglion cell degeneration extending from the nasal retina to the fovea in the right eye and from the temporal retina to the fovea in the left eye. In this patient, retrochiasmal defects resulted in RNFL defects corresponding to homonymous hemianopia without a visual field defect. Therefore, SD-OCT can be used to rule out a preperimetric homonymous hemianopia. This information would help to confirm the existence of an optic tract lesion before visual field defects.

To evaluate the influence of H(2)O(2) on lens epithelial cells (LECs) and to determine the effect of the Janus kinase (JAK) inhibitor AG490 and the mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK) kinase (MEK) inhibitor U0126 on LEC death after H(2)O(2) exposure.Human lens epithelial (HLE) B-3 cells were cultured. Cells were treated for 45 min with H2O2 and signal transducers and activators transcription (STAT) 3, JAK2, and ERK1/2 phosphorylation were surveyed by Western blot analysis. After pretreatment with either 40 microM AG490 or 25 microM U0126, LECs were exposed to H(2)O(2). LEC death was evaluated by microscopy and flow cytometry.H(2)O(2) induced phosphorylation of Tyr-705 STAT3, JAK2, and ERK1/2 in LECs. In cells pretreated with both AG490 and U0126, phosphorylation of Tyr-705 STAT3, JAK2, and ERK1/2 was suppressed. Microscopic findings, however, showed that only AG490 noticeably enhanced cell survival, and flow cytometry showed that cell necrosis decreased to 4.05% after pretreatment with 40 microM AG490.AG490 may prevent H(2)O(2)-induced LEC death by blocking an unknown necrosis pathway. Further investigation is required to characterize that pathway.

Purpose To evaluate retinal nerve fiber layer (RNFL) thickness with optical coherence tomography (OCT) in early stage ethambutol optic neuropathy. Methods The RNFL thickness of 20 eyes of 10 patients who developed optic neuropathy after taking ethambutol and visited within 6 months after onset were analyzed and compared with those of 54 eyes of 29 healthy age-matched controls. The mean age was 67.40+/-10.25 years for the patients with toxic optic neuropathy and 66.78+/-10.60 for the control group (p=0.948). A full ophthalmologic examination including RNFL evaluation with fast RNFL thickness (3.4) scanning using a Stratus OCT (Carl Zeiss Meditec, Dublin, CA) was performed. Results RNFL thicknesses associated with early ethambutol optic neuropathy were as follows: temporal 75.35+/-15.77 microm, superior 124.05+/-24.62 microm, nasal 75.15+/-24.23 microm, inferior 127.60+/-22.91 mum, and the average was 100.83+/-16.56 microm. There was no significant difference between the RNFL thickness of the patients with the early stage of ethambutol optic neuropathy and those of the control group. The thickness of RNFL was greater in the temporal quadrant than the nasal quadrant, although not statistically significant. Conclusions RNFL thickness associated with ethambutol optic neuropathy during the early stages was no different from the controls. Although not statistically significant, the relative thickening of temporal RNFL in our patients might represent a mild swelling of the papillomacular bundle.

Purpose We evaluated fundus and fluorescein angiography (FAG) findings and characteristics that can help distinguish nonarteritic anterior ischemic optic neuropathy (NAION) from optic neuritis (ON). Methods Twenty-three NAION patients and 17 ON with disc swelling patients were enrolled in this study. We performed fundus photography and FAG. The disc-swelling pattern, hyperemia grade, presence of splinter hemorrhages, cotton-wool spots, artery/vein ratio and degree of focal telangiectasia were investigated. The FAG findings for each patient were compared with respect to the following features: the pattern of disc leakage in the early phase, arteriovenous (artery/vein) transit time (second), and the presence and pattern of the filling delay. Results Cotton-wool spots, focal telangiectasia, and venous congestion were more common in the affected eyes of NAION patients. Upon FAG, 76.5% of the patients in the ON group exhibited normal choroidal circulation. However, 56.5% of patients in the NAION group demonstrated abnormal filling defects, such as peripapillary, generalized, or watershed zone filling delays. Conclusions Fundus findings, including cotton-wool spots, focal telangiectasia, and venous congestion in the affected eye, may be clues that can be used to diagnose NAION. In addition, choroidal insufficiencies on FAG could be also helpful in differentiating NAION from ON.

Results of conservative management for consecutive esotropia after intermittent exotropia surgery

This article reports a case of papillitis occurring after the patient was stung on the hand by bees. A healthy 27-year-old man with no specific disease complained of a decrease in visual acuity in the right eye 3 days after he was stung by five bees on the right hand. The best corrected visual acuity was 20/20 in both eyes and anterior segment examination findings and pupil response were normal. Fundus examination, however, revealed optic disc swelling in the right eye. No abnormalities were detected in a visual field test, visual evoked potential examination, serologic test, or cerebral spinal fluid test and brain magnetic resonance imaging studies. No specific treatment was administered, and the optic swelling improved in 2 weeks. Three months later, however, temporal pallor of the optic disc and a retinal nerve fibre defect were observed in the temporal and nasal sides. These findings persisted for 6 months.