PURPOSE: To analyze innervated myotendinous cylinders (IMCs) in the extraocular muscles (EOMs) of normal subjects and strabismic patients. METHODS: The rectus muscles of 37 subjects were analyzed. Distal myotendinous specimens were obtained from 3 normal subjects, 20 patients with acquired strabismus, 11 with infantile strabismus, and from 3 with congenital nystagmus, and were studied by using light microscopy. Some specimens (6 rectus muscles) were also examined by transmission electron microscopy. RESULTS: IMCs were found in the distal myotendinous regions of EOMs. The IMCs of patients with acquired strabismus showed no significant morphological alterations. However, significant IMCs alterations were observed at the distal myotendinous junction of patients with congenital strabismus and congenital nystagmus. CONCLUSIONS: This study supports the notion that IMCs in human EOMs function mainly as proprioceptors, along with effector properties, and a disturbance of ocular proprioceptors plays an important role in the pathogenesis of oculomotor disorder. We suggest that a proprioceptive feedback system should be stimulated and calibrated early in life for the development of binocular vision.

BACKGROUND/AIMS: To analyze the clinical manifestations and results of treatment for patients with retinoblastoma in Korea. METHODS: We retrospectively analyzed the medical records of 70 children (92 eyes) diagnosed with retinoblastoma and treated between 2000 and 2006. Data on gender, age at diagnosis, laterality, presenting sign, classification of tumor, treatment modality, and prognosis were collected. RESULTS: The most common presenting sign was leukocoria (80%). 31.4% developed bilateral retinoblastoma. Using the International Classification of Retinoblastoma, 7.5% were group A, 23.8% were group B, 6.3% were group C, 38.8% were group D, and 23.8% were group E. 26.1% of eyes were treated with chemoreduction and/or focal therapy, namely, they achieved globe preservation and all other eyes were enucleated. The globe preservation was achieved in 100% of group A, 77.8% of group B, 66.7% of group C, and 26.7% of group D. CONCLUSIONS: In Korea, most of children with retinoblastoma showed advanced stage of tumor at time of diagnosis and although they are treated with update therapeutic approach according to the newly introduced classification, the rate of globe preservation did not reach developed countries. Increased surveillance should be performed.

PURPOSE: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes after Ahmed glaucoma valve insertion. SETTING: Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea. METHODS: The files of 13 patients who received phacoemulsification after Ahmed glaucoma valve insertion were reviewed in this retrospective case series. Visual acuity, IOP, and the number of glaucoma medications before phacoemulsification were used as a baseline for comparison with the values at various follow-up intervals. RESULTS: The mean IOP before phacoemulsification was 15.1 mm Hg +/- 3.6 (SD). Postoperatively, it was 12.8 +/- 4.5 mm Hg, 13.1 +/- 3.6 mm Hg, 16.4 +/- 5.2 mm Hg, 15.8 +/- 4.0 mm Hg, 16.1 +/- 3.9 mm Hg, 15.3 +/- 4.1 mm Hg, and 15.2 +/- 3.4 mm Hg at 1 day after 1 week, at 1, 2, 6, and 12 months, and at last visits, respectively. The mean IOP did not differ significantly from the prephacoemulsification value at any follow-up. The number of glaucoma medications increased significantly after phacoemulsification (P =.031), and 6 of 13 eyes required additional glaucoma medication because of IOP elevation at approximately 1 month. CONCLUSIONS: Temporal clear corneal phacoemulsification did not increase IOP significantly in eyes with prior Ahmed glaucoma valve insertion. However, some eyes experienced an IOP elevation 1 month after phacoemulsification and required glaucoma medication.

OBJECTIVE: To evaluate the clinical outcomes of macular laser photocoagulation after the intravitreal injection of 4 mg of triamcinolone acetonide (IVTA) for diffuse diabetic macular edema (DME). METHODS: Eighty-six eyes of 74 patients with diffuse DME were randomized into 2 groups. The laser group eyes (n = 48) were subjected to a macular grid laser photocoagulation 3 weeks after IVTA. The control group eyes (n = 38) underwent only IVTA. Both groups were compared with regard to the changes in visual acuity and central macular thickness at 3 weeks, 3 months, and 6 months after IVTA. RESULTS: The mean central macular thickness before, 3 weeks after, and 3 and 6 months after IVTA were 538, 250, 295, and 301 mum in the laser group vs 510, 227, 302, and 437 mum in the control group, respectively. The logMAR visual acuities were not significantly different between the 2 groups at baseline and at 3 weeks after IVTA but were significantly better in the laser group at 3 (P =.02) and 6 months (P<.001) after IVTA. CONCLUSIONS: Macular laser coagulation effectively maintains improved visual acuity after IVTA for diffuse DME and is believed to reduce recurrent DME after IVTA.

BACKGROUND: Lacrimal gland choristoma manifesting in the ciliary body is quite rare. We report a case of lacrimal gland choristoma manifesting in the ciliary body, coupled with orbital cellulites, in an infant. CASE: A 10-month-old female infant with swelling and tenderness of the right upper eyelid. OBSERVATIONS: The results of ophthalmic examinations of the patient were consistent with orbital cellulitis. During the funduscopic examination, a fleshy mass was incidentally detected at the superotemporal portion of the ciliary body in the right eye. A local resection of the lesion was carried out. The results of a pathologic examination showed lacrimal gland choristoma of the ciliary body that was accompanied by an epithelia-lined cyst. The patient has had no hypotonia or enlargement of the lesion for 1 year after surgery. CONCLUSION: Lacrimal gland choristoma should be included in the differential diagnosis of a ciliary body mass in pediatric patients. Jpn J Ophthalmol 2006;50:100-102 (c) Japanese Ophthalmological Society 2006.

PURPOSE: To characterize cross-sectional images of idiopathic polypoidal choroidal vasculopathy (PCV). METHODS: A cross-sectional and retrospective study was performed involving 28 eyes with PCV and 112 eyes with exudative age-related macular degeneration. The frequency and dimensions of the retinal pigment epithelial detachment (RPED) with attenuation of internal reflectivity on optical coherence tomographic (OCT) examination were compared in both diseases. RESULTS: OCT showed the RPED with attenuation of internal reflectivity corresponding to the polypoidal structure in the indocyanine green angiogram in 75% of eyes with PCV, which was significantly more frequent than in eyes with exudative age-related macular degeneration (3.6%). In lesions suspicious of exudative age-related macular degeneration or PCV, the RPED with attenuation of internal reflectivity on OCT images strongly supported PCV diagnosis with a sensitivity of 84% and a specificity of 94%. The base diameter (p=0.010) and base diameter times height (p=0.028) of RPED were smaller in PCV than in exudative age-related macular degeneration. CONCLUSIONS: An RPED with attenuation of internal reflectivity in OCT examination is a highly sensitive and specific finding which characterizes PCV. Recognition of this RPED appearance, as well as the evaluation of its size, aids in the diagnosis of PCV.

BACKGROUND AND OBJECTIVE: Abnormalities of extraocular muscle are an unusual cause of complex strabismus. The traditional evaluation based on clinical examinations is insufficient for the interpretation of incomitant motility disorders resulting from extraocular muscle anomalies. Extraocular muscle imaging by computed x-ray tomography (CT) or magnetic resonance imaging (MRI) can provide useful information for diagnosis, pathophysiology, and treatment of complex strabismus. PATIENTS AND METHODS: Five cases of complex strabismus resulting from congenital anomalies of the extraocular muscles and their successful evaluation using extraocular muscle imaging are described. RESULTS: Orbital CT or MRI scan was obtained in five patients who had unusual incomitant strabismus. It confirmed the diagnosis of the absence of the medial rectus muscle, accessory lateral rectus muscle, atrophy of the inferior or both superior and medial rectus muscles, and abnormal thickening of the levator palpebrae superioris and superior rectus muscle. CONCLUSIONS: Extraocular muscle imaging is a useful technique for evaluating anatomic abnormalities. It should be considered when evaluating patients with atypical strabismus.

PURPOSE: To present a case of inflammatory myofibroblastic tumor in the anterior orbit and to describe its clinical features, diagnosis, and management. METHODS: Case report and literature review. RESULTS: A 10-year-old boy presented with diplopia and limited ocular motility in his right eye secondary to a subconjunctival mass in the right supranasal side. Incisional biopsy and debulking were performed. Histopathologic examination showed the proliferation of spindle-shaped myofibroblasts that were immunoreactive for smooth muscle actin and vimentin and infiltrate of inflammatory cells. CONCLUSIONS: We believe this is the first case of an inflammatory myofibroblastic tumor found localized in the orbit.