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Pathophysiology and diagnosis of congenital periodic alternating nystagmus
ABSTRACTS
Abstracts of Published Articles in Nippon Ganka Gakkai Zasshi (Journal of the Japanese Ophthalmological Society) Early Clinical Results of Laser Epithelial Keratomileusis Purpose: To evaluate the efficacy of laser epithelial keratomileusis (LASEK). Subjects and Method: LASEK was performed on 82 eyes of 42 patients whose spherical refraction ranged from ⫺0.75 to ⫺12.00 D (mean, ⫺6.09 D) and cylindrical refraction ranged from 0 to ⫺5.00 D (mean, ⫺0.95 D). LASEK is a method of making an epithelial flap using 20% ethanol and repositioning the flap after excimer laser ablation. The clinical results of postoperative refraction and complications were examined. Results: At 1 week and 1 month after the operation, 69 eyes (84.1%) and 79 eyes (96.3%) achieved an uncorrected visual acuity of 20/20 or better. At 1 week and 1 and 3 months after the operation, the mean spherical refraction was ⫹0.09 ⫾ 0.49 (mean ⫾ standard deviation) D, ⫹0.29 ⫾ 0.47 D, ⫹0.13 ⫾ 0.46 D, At 1 month 65 eyes (79.3%) were within ⫾ 0.5 D and 78 eyes (95.1%) were within ⫾ 1.0 D; 51 eyes (62.2%) had the complication of corneal haze. Conclusion: LASEK achieved good uncorrected visual acuity, but there were some complications such as postoperative pain, the delayed recovery of visual acuity, and corneal haze, so that a long and careful follow-up seems necessary. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:249–256, 2003)
display. Before and after the trial task and the outward shift stimuli, their accommodative step response was measured and their subjective symptoms were assessed. The outward shift stimuli in the optical system, which was set on a refractometer, were presented by moving the target scenery images from far to near and near to far repetitively for both eyes at the far point position. At the same time as the accomodation measurements, the changes of refraction were recorded in the same eye. Results: While looking at the outward shift stimuli, the refraction of 9 out of 20 subjects showed an outward shift and that of the other 11 subjects shifted inward. The post-trial value of contraction (from far to near) time of the accommodative step response in the inward-shift group was markedly prolonged, from 0.86 s to 0.97 s (p ⫽ 0.043), and the post-trial accommodative power at the far target was shifted outward; from ⫹1.21 D to ⫹1.13 D (p ⫽ 0.048). The subjective symptoms of ‘‘ocular fatigue’’, ‘‘eye heaviness’’ and ‘‘eye dryness’’ also increased after the inward shift (p ⫽ 0.0035, p ⫽ 0.0038, p ⫽ 0.0162, respectively). In the outward-shift group, however, there was no statistically significant change. Conclusion: From these results, we suggest that accommodative relaxation produced by outward shift stimuli is effective in the reduction of asthenopia following the deterioration of accommodative functions. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:257– 264, 2003)
Yoshihiro Kitazawa, Hideaki Sawai, Chizuko Tajiri, Kumiko Toshida and Mototsugu Saishin
Tsuneto Iwasaki*, Akihiko Tawara* and Nobuyuki Miyake†
Ai Eye Clinic
*Department of Ophthalmology, University of Occupational and Environmental Health, Japan; † Business Development Center, Nikon Corporation
doi:10.1016/j.jjo.2003.09.004
doi:10.1016/j.jjo.2003.09.005
Reduction of Asthenopia Achieved by Accommodative Relaxation Purpose: We investigated experimentally the effect on asthenopia of accommodative relaxation by outward shift stimuli. Methods: Twenty female students fixed on optical outward-shift stimuli at accommodation for 2 min immediately after 15 min of a sustained task on a 3-D Jpn J Ophthalmol 47, 623–627 (2003) 쑖 2003 Japanese Ophthalmological Society Published by Elsevier Science Inc.
Pathophysiology and Diagnosis of Congenital Periodic Alternating Nystagmus Purpose: Not many cases of congenital periodic alternating nystagmus have been reported in Japan. We investigated the pathophysiology and diagnosis of 0021-5155/03/$–see front matter
Jpn J Ophthalmol Vol 47: 623–627, 2003
624
congenital periodic alternating nystagmus, noting the age when this disease began, which had not been reported previously. Subjects: Ninety-one patients with congenital nystagmus who were seen in our department in the Teikyo University School of Medicine between July 1994 and January 2002 were studied. Results: Eighteen patients (19.8%) among the 91 congenital nystagmus patients were diagnosed with congenital periodic alternating nystagmus. A manifestation of the periodic face turning was seen between the ages of 3 and 9 years. Visual acuity over 0.6 with correction was obtained in all patients. Almost all the patients had an asymmetric cycle of null point shifting, and the face turning was seen at one side for a long time. Conclusion: When we see congenital nystagmus patients whose face turning alters periodically with fairly good vision over the age of three, we must check out the direction of jerk nystagmus changes at the same gazing point using electronystagmography or video cassette recording to detect the possibility of congenital periodic alternating nystagmus. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:265–272, 2003) Takao Hayashi*,†, Fumiyo Hasegawa*,†, Chie Usui† and Nobue Kubota† *Department of Ophthalmology, Seibo International Catholic Hospital; †Department of Ophthalmology, Teikyo University School of Medicine doi:10.1016/j.jjo.2003.09.006
Natural Killer-cell Lymphoma of the Iris with a Normal Fundus Background: Intraocular lymphoma is a relatively uncommon malignancy, rarely presenting with exclusively anterior segment findings in a normal fundus. Case: A 38-year-old male, previously diagnosed with nasal lymphoma, currently in complete remission after chemotherapy and radiotherapy, presented with blurring of vision in his left eye, which initially responded to local steroid therapy. However, the patient developed resistance to steroid therapy and developed nodular masses in the left iris. Ultrasound biomicroscopy revealed diffuse thickenings leading to a complex and uneven shape of the left iris. An iris biopsy was done which led to the diagnosis of natural killer (NK) -cell lymphoma. Radiation therapy was instituted which led to rapid resolution of both the nodular masses and iritis. Conclusion: This is a case of malignant lymphoma presenting as metastasis to the iris without involve-
ment of the chorioretinal tissues. When encountering a patient with iritis resistant to steroid therapy, clinical ophthalmologists should consider metastatic malignancy in the differential diagnosis. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:273–278, 2003) Yoriko Nakanishi*, Kazuaki Miyamoto*, Masashi Kikuchi*, Takehisa Kondo*, Takayuki Takahashi†, Kimio Fujii‡, Noriko Ogo‡, Keisuke Hanioka§ and Hirofumi Shirane§ *Department of Ophthalmology, Kobe City General Hospital; †Department of Hematology and Immunology, Kobe City General Hospital; ‡Department of Dermatology, Kobe City General Hospital; §Department of Pathology, Kobe City General Hospital doi:10.1016/j.jjo.2003.09.007
Choroidal Melanoma Complicated by Central Retinal Vein Occlusion Background: Various complications for choroidal melanoma have been reported. However, there are no reports on choroidal melanoma complicated by central retinal vein occlusion. Case Report: A 37-year-old male showed an elevated yellowish white tumor of about 8 discs in diameter, and involving the optic disc in the left eye. Serous retinal detachment and subretinal exudate were noted around the tumor. Central retinal vein occlusion occurred concurrently. Fluorescein angiography revealed blocks due to hemorrhage and fluorescein leakage from the retinal vein. Dilation of retinal capillary vessels and marked leakage of fluorescein from the retinal vein and capillary vessels were found in the tumorous region. In the late stage, the entire tumor presented hyperfluorescence. On indocyanine green angiography, the tumor on the whole presented hypofluorescence from the early to late stage, and an insular hyperfluorescence suggestive of the presence of intratumor vessels with leakage of fluorescein was seen inside. Ultrasonography revealed choroidal excavation. General examination showed no abnormality. On the basis of these findings the patient was diagnosed with choroidal melanoma. Conclusion: We report a case of choroidal melanoma, which was complicated by central retinal vein occlusion caused by mechanical compression and invasion of the optic disc. These findings were not reported in the first medical examination. We must be careful in our diagnosis in such cases. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:279–286, 2003)
Abstracts of Published Articles in Nippon Ganka Gakkai Zasshi (Journal of the Japanese Ophthalmological Society) Early Clinical Results of Laser Epithelial Keratomileusis Purpose: To evaluate the efficacy of laser epithelial keratomileusis (LASEK). Subjects and Method: LASEK was performed on 82 eyes of 42 patients whose spherical refraction ranged from ⫺0.75 to ⫺12.00 D (mean, ⫺6.09 D) and cylindrical refraction ranged from 0 to ⫺5.00 D (mean, ⫺0.95 D). LASEK is a method of making an epithelial flap using 20% ethanol and repositioning the flap after excimer laser ablation. The clinical results of postoperative refraction and complications were examined. Results: At 1 week and 1 month after the operation, 69 eyes (84.1%) and 79 eyes (96.3%) achieved an uncorrected visual acuity of 20/20 or better. At 1 week and 1 and 3 months after the operation, the mean spherical refraction was ⫹0.09 ⫾ 0.49 (mean ⫾ standard deviation) D, ⫹0.29 ⫾ 0.47 D, ⫹0.13 ⫾ 0.46 D, At 1 month 65 eyes (79.3%) were within ⫾ 0.5 D and 78 eyes (95.1%) were within ⫾ 1.0 D; 51 eyes (62.2%) had the complication of corneal haze. Conclusion: LASEK achieved good uncorrected visual acuity, but there were some complications such as postoperative pain, the delayed recovery of visual acuity, and corneal haze, so that a long and careful follow-up seems necessary. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:249–256, 2003)
display. Before and after the trial task and the outward shift stimuli, their accommodative step response was measured and their subjective symptoms were assessed. The outward shift stimuli in the optical system, which was set on a refractometer, were presented by moving the target scenery images from far to near and near to far repetitively for both eyes at the far point position. At the same time as the accomodation measurements, the changes of refraction were recorded in the same eye. Results: While looking at the outward shift stimuli, the refraction of 9 out of 20 subjects showed an outward shift and that of the other 11 subjects shifted inward. The post-trial value of contraction (from far to near) time of the accommodative step response in the inward-shift group was markedly prolonged, from 0.86 s to 0.97 s (p ⫽ 0.043), and the post-trial accommodative power at the far target was shifted outward; from ⫹1.21 D to ⫹1.13 D (p ⫽ 0.048). The subjective symptoms of ‘‘ocular fatigue’’, ‘‘eye heaviness’’ and ‘‘eye dryness’’ also increased after the inward shift (p ⫽ 0.0035, p ⫽ 0.0038, p ⫽ 0.0162, respectively). In the outward-shift group, however, there was no statistically significant change. Conclusion: From these results, we suggest that accommodative relaxation produced by outward shift stimuli is effective in the reduction of asthenopia following the deterioration of accommodative functions. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:257– 264, 2003)
Yoshihiro Kitazawa, Hideaki Sawai, Chizuko Tajiri, Kumiko Toshida and Mototsugu Saishin
Tsuneto Iwasaki*, Akihiko Tawara* and Nobuyuki Miyake†
Ai Eye Clinic
*Department of Ophthalmology, University of Occupational and Environmental Health, Japan; † Business Development Center, Nikon Corporation
doi:10.1016/j.jjo.2003.09.004
doi:10.1016/j.jjo.2003.09.005
Reduction of Asthenopia Achieved by Accommodative Relaxation Purpose: We investigated experimentally the effect on asthenopia of accommodative relaxation by outward shift stimuli. Methods: Twenty female students fixed on optical outward-shift stimuli at accommodation for 2 min immediately after 15 min of a sustained task on a 3-D Jpn J Ophthalmol 47, 623–627 (2003) 쑖 2003 Japanese Ophthalmological Society Published by Elsevier Science Inc.
Pathophysiology and Diagnosis of Congenital Periodic Alternating Nystagmus Purpose: Not many cases of congenital periodic alternating nystagmus have been reported in Japan. We investigated the pathophysiology and diagnosis of 0021-5155/03/$–see front matter
Jpn J Ophthalmol Vol 47: 623–627, 2003
624
congenital periodic alternating nystagmus, noting the age when this disease began, which had not been reported previously. Subjects: Ninety-one patients with congenital nystagmus who were seen in our department in the Teikyo University School of Medicine between July 1994 and January 2002 were studied. Results: Eighteen patients (19.8%) among the 91 congenital nystagmus patients were diagnosed with congenital periodic alternating nystagmus. A manifestation of the periodic face turning was seen between the ages of 3 and 9 years. Visual acuity over 0.6 with correction was obtained in all patients. Almost all the patients had an asymmetric cycle of null point shifting, and the face turning was seen at one side for a long time. Conclusion: When we see congenital nystagmus patients whose face turning alters periodically with fairly good vision over the age of three, we must check out the direction of jerk nystagmus changes at the same gazing point using electronystagmography or video cassette recording to detect the possibility of congenital periodic alternating nystagmus. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:265–272, 2003) Takao Hayashi*,†, Fumiyo Hasegawa*,†, Chie Usui† and Nobue Kubota† *Department of Ophthalmology, Seibo International Catholic Hospital; †Department of Ophthalmology, Teikyo University School of Medicine doi:10.1016/j.jjo.2003.09.006
Natural Killer-cell Lymphoma of the Iris with a Normal Fundus Background: Intraocular lymphoma is a relatively uncommon malignancy, rarely presenting with exclusively anterior segment findings in a normal fundus. Case: A 38-year-old male, previously diagnosed with nasal lymphoma, currently in complete remission after chemotherapy and radiotherapy, presented with blurring of vision in his left eye, which initially responded to local steroid therapy. However, the patient developed resistance to steroid therapy and developed nodular masses in the left iris. Ultrasound biomicroscopy revealed diffuse thickenings leading to a complex and uneven shape of the left iris. An iris biopsy was done which led to the diagnosis of natural killer (NK) -cell lymphoma. Radiation therapy was instituted which led to rapid resolution of both the nodular masses and iritis. Conclusion: This is a case of malignant lymphoma presenting as metastasis to the iris without involve-
ment of the chorioretinal tissues. When encountering a patient with iritis resistant to steroid therapy, clinical ophthalmologists should consider metastatic malignancy in the differential diagnosis. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:273–278, 2003) Yoriko Nakanishi*, Kazuaki Miyamoto*, Masashi Kikuchi*, Takehisa Kondo*, Takayuki Takahashi†, Kimio Fujii‡, Noriko Ogo‡, Keisuke Hanioka§ and Hirofumi Shirane§ *Department of Ophthalmology, Kobe City General Hospital; †Department of Hematology and Immunology, Kobe City General Hospital; ‡Department of Dermatology, Kobe City General Hospital; §Department of Pathology, Kobe City General Hospital doi:10.1016/j.jjo.2003.09.007
Choroidal Melanoma Complicated by Central Retinal Vein Occlusion Background: Various complications for choroidal melanoma have been reported. However, there are no reports on choroidal melanoma complicated by central retinal vein occlusion. Case Report: A 37-year-old male showed an elevated yellowish white tumor of about 8 discs in diameter, and involving the optic disc in the left eye. Serous retinal detachment and subretinal exudate were noted around the tumor. Central retinal vein occlusion occurred concurrently. Fluorescein angiography revealed blocks due to hemorrhage and fluorescein leakage from the retinal vein. Dilation of retinal capillary vessels and marked leakage of fluorescein from the retinal vein and capillary vessels were found in the tumorous region. In the late stage, the entire tumor presented hyperfluorescence. On indocyanine green angiography, the tumor on the whole presented hypofluorescence from the early to late stage, and an insular hyperfluorescence suggestive of the presence of intratumor vessels with leakage of fluorescein was seen inside. Ultrasonography revealed choroidal excavation. General examination showed no abnormality. On the basis of these findings the patient was diagnosed with choroidal melanoma. Conclusion: We report a case of choroidal melanoma, which was complicated by central retinal vein occlusion caused by mechanical compression and invasion of the optic disc. These findings were not reported in the first medical examination. We must be careful in our diagnosis in such cases. Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc 107:279–286, 2003)