A 30-year-old male presented to the emergency department with a complaint of acute headache with pain in the right eye and simultaneous weakness and numbness on his left side. Results of ophthalmic examinations showed limited abduction and adduction only in the right eye, while the vertical movement was normal. Mild ptosis with concurrent miosis oculus dexter was also found. A neurological examination revealed left hemiplegia, left hemiparesthesia, left-side sensory ataxia, right facial palsy, and right facial analgesia. Computer tomography revealed a 2.4-cm high-density hemorrhage in the bilateral dorsal aspect of pons, more at the right side. Foville’s syndrome with ipsilateral internuclear ophthalmoplegia was diagnosed and the patient received supportive treatment. The patient later complained of left hearing loss and the brainstem auditory evoked potential study suggested a peripheral lesion. Follow-up magnetic resonance imaging studies at the 3^rd and 10^th months showed old pontine hemorrhage with right hypertrophic olivary degeneration (HOD). We reported a rare case of Foville’s syndrome with ipsilateral internuclear ophthalmoplegia due to spontaneous pontine hemorrhage. The clinical manifestations correlated well with anatomical involvement. The sequela of HOD after potine hemorrhage should be monitored for the possible late-onset movement disorder.

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Purpose: To investigate patients with pterygium in different geographic regions and the associated risk factors in southern Taiwan. Methods: A clinical observation survey was conducted in Chiayi County, a rural area in southern Taiwan. The subjects aged 40 years and above underwent complete ocular examinations. Associated risks factors were evaluated, including gender, age, occupations, smoking, and geographical living regions by univariant and multivariant logistic regression analysis. Results: A total of 2197 participants (790 male, 36.0%) from 44 different villages were evaluated. In these, 554 participants (25.2%) have either unilateral or bilateral pterygium. Age is associated with the percentage of pterygium, and those aged between 60 and 69 had the highest percentage of 30.1% (p < 0.0001). The gender effect was higher among men than women (OR = 1.31, 95% CI: 1.08–1.60, p = 0.006). The percentage of pterygium lived in plain, seaside, and mountainous areas were 22.6%, 32.6%, and 14.5% respectively. Geographical regions also showed that seaside area had the highest percentage of pterygium (seaside area OR = 1.65, 95% CI: 1.35-2.03, and mountainous area OR = 0.58,95% CI: 0.35-0.95 compared with plain areas). Primary outdoor workers and residents with smoking history had relative higher risk for pterygium (OR = 1.47, 95% CI: 1.17-1.86; OR = 1.36, 95% CI: 1.02-1.83). Conclusions: The percentage of pterygium in southern Taiwan is about 25.2% among adults aged over 40 years in this survey. It is significantly higher in the age of 50 or more and in residents living in villages along the seaside than those living in the mountainous and the plain areas.

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Purpose: To investigate the influence of tropicamide 1% (as a cycloplegic mydriatic) and phenylephrine 10% (as a noncycloplegic mydriatic) on mydriasis, wavefront refraction, and wavefront aberrations. Methods: In this prospective study, 31 myopic eyes with a large mesopic pupil size were evaluated with an Allegretto Wave analyzer in a natural dilated state, after instillation of tropicamide 1% or phenylephrine 10%. Aberrations expressed as Zernike polynomials up to the sixth order were analyzed. Wavefront refractions were compared with subjective manifest refraction. Results: Both tropicamide and phenylephrine cause significant mydriasis (p < 0.001), but phenylephrine induced a larger pupil size than tropicamide under mesopic conditions (p = 0.029). Compared with the natural state, tropicamide induced a significant hyperopic shift in wavefront refraction (by +0.27 ± 0.09 D; p = 0.002). In contrast, wavefront refraction did not significantly change when using phenylephrine as the mydriatic (+0.03 ± 0.10 D; p = 0.75). Compared with the subjective manifest refraction, wavefront refraction before mydriatics and after phenylephrine showed a significant myopic shift (p < 0.0125), whereas the wavefront refraction after tropicamide was not significantly different from subjective refraction. Zernike coefficient C4 showed a less positive defocus after application of tropicamide (p = 0.0017). Other aberration coefficients of Zernike polynomials up to the sixth order did not change significantly from before to after tropicamide application. There was no significant difference in Zernike coefficients up to C27 before and after phenylephrine. Conclusion: Phenylephrine preserves accommodation and provides a larger pupil under mesopic conditions, whereas tropicamide relaxes accommodation and provides an objective wavefront refraction that is closer to the subjective manifest refraction. Neither phenylephrine nor tropicamide causes a significant change in high-order aberrations from the natural state.

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The renin–angiotensin system (RAS) plays pivotal roles in homeostasis, but its abnormal activation has been proposed as a risk factor for several disorders including diabetes. Using animal models, we previously clarified the molecular mechanisms in which tissue RAS stimulates retinal angiogenesis and the critical roles of (pro)renin receptor [(P)RR] in retinal RAS activation and its concurrent intracellular signal transduction, i.e., the receptor-associated prorenin system (RAPS). Most recently, we have revealed that (P)RR is associated with vascular endothelial growth factor (VEGF)-driven angiogenic activity in human proliferative diabetic retinopathy (DR), and also showed a close relationship between vitreous renin activity and VEGF-induced pathogenesis of DR. These findings suggest that both vitreous RAS and retinal RAPS are tightly linked to the molecular pathogenesis of DR.

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Warthin’s tumor is an extremely rare lesion of the lacrimal caruncle, and ophthalmologists may never encounter this lesion in their careers. In addition, pathologists see this lesion in salivary gland tissues, but not in specimens submitted from the anatomic eye. Here, we report a rare case of a Warthin’s tumor originating in a lacrimal caruncle.

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Purpose: A new tube, Metaireau tube (M-tube), was examined for its proficiency, durability, and safety for use in conjunctivodacryocystorhinostomy (CDCR). The frequent complications associated with this procedure and Jones tubes, such as tube migration, pyogenic granuloma, and tube obstruction, were particularly checked. Methods: The study was a retrospective interventional case series conducted at a single institution between January 2009 and October 2012. An M-tube was used in 13 cases of external CDCR and four endoscopic CDCR. Ten cases were females and seven were males. Patients aged from 20 years old to 82 years old, mean 52.7 years. Six cases were complicated traumatic canalicular laceration. Five cases were replacement of lost or dislocated Jones tubes. The M-tube is flexible and slick. The tube length that remains in the nasal cavity is adjustable by scissor trimming with endoscopic observation. Results: The surgery was uneventful. The tear drainage function works well when the tube is in situ. Twelve cases developed dry eye requiring artificial tear postoperatively. Nasal migration of the tube is frequently encountered in the early postoperative period (5/17, 29.4%). Reposition is easy using an endoscope. The tube is pulled out from the nose and replaced in the original tract. Mild tube extrusion occurred in one case without epiphora. Granuloma developed in one case. The follow-up took place from 2 months to 36 months, mean 21.6 months. Conclusion: The M-tube is easy to use in either external or endoscopic CDCR. When dislocated, the tube is simple to reposition. Frequent follow-up in the postoperative 6 months is suggested for early detection of minor migration.

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Purpose: To evaluate visual acuity (VA), refractive outcome, endothelial cell loss rate and complications of Descemet’s stripping and automated endothelial keratoplasty (DSAEK) combined with phacoemulsification and intraocular lens (IOL) implantation in patients with coexisting corneal endothelial dysfunction and cataracts. Methods: Seventeen patients underwent phacoemulsification and posterior chamber IOL implantation- through temporal corneal incision, followed by DSAEK. The selection of IOL power was predicted by preoperative lens power calculations of fellow eye plus 0.5 to 1.0 diopters (D). Results: There were five cases of laser iridotomy induced corneal dysfunction, four cases of Fuch’s dystrophy, three cases of cytomegalovirus (CMV) endotheliitis, three cases of iridocorneal endothelial (ICE) syndrome, one case of herpes simplex virus (HSV) endotheliitis, and one case with an unknown cause. The BSCVAs were all under 0.2 preoperatively, and the average BSCVA was 0.3 postoperatively. The postoperative spherical equivalent (SE) refractive error was −0.11 D on an average. The endothelial cell loss rate was −36.86% at 6 months and −38.60% at 12 months. There was one case of graft rejection at 6 months, and one case of primary graft failure. Complications such as donor detachment, pupillary block, donor graft folds, epithelial ingrowth, or interface scar did not occur. Conclusion: This case series of DSAEK combined with phacoemulsification and IOL implantation suggests that the procedure provides rapid visual rehabilitation and allows the selection of an appropriate IOL.

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A 62-year-old male developed ocular ischemic syndrome in his right eye. Carotid angiography and magnetic resonance angiography revealed total occlusion of the right internal carotid artery and a 53% occlusion of the left internal carotid artery. The angiographies also revealed a collateral circulation of a rarely seen reversed blood flow in the right ophthalmic artery, which helped spare the patient from cerebral stroke. Nevertheless, retinal infarction and neovascularization of the iris, retina, and optic disc presented with an unrecoverable visual loss. The balance between treating eye ischemia or cerebral ischemia is a challenge, and timely referral to a neuroradiologist and neurovascular specialist is important to avoid further serious life-threatening complications.

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Background/Purpose: To evaluate the effect of intravitreal bevacizumab on subretinal fluid absorption in patients with chronic central serous chorioretinopathy (CSCR). Materials and methods: This was a retrospective case series study. Patients with CSCR symptoms for > 3 months and who received intravitreal injection of bevacizumab were included. Ocular examinations were carried out at baseline and every follow-up visit, including visual acuity, fundus examination, and optic coherence tomography. Results: Twelve eyes in 12 patients were included in this study. One month after injection, three of the 12 patients who had increased central macular thickness were considered nonresponders. Nine of the 12 patients who had decreased central macular thickness were considered to have responded to intravitreal bevacizumab injection. The response rate was 75%. In the response group, the mean central macular thickness significantly decreased, from 306.7 ± 77.8 μm to 204.3 ± 59.3 μm (p = 0.001) at 1 month. The mean Logarithm of the Minimum Angle of Resolution (logMAR) visual acuity was significantly improved from 0.72 ± 0.35 to 0.50 ± 0.28 (p = 0.008). Six of these nine patients had stable conditions lasting > 6 months. Three of them had recurrence. Conclusion: Intravitreal bevacizumab injections improved subretinal fluid absorption in some patients with CSCR. It could be an alternative therapy for patients with CSCR, especially when they are not suitable for other treatments.

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