中華民國眼科醫學會雜誌
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中華民國眼科醫學會,停刊
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運動視覺是指運動時需要的視覺能力。運動視覺研究包括：運動 視覺的測量、訓練及視覺功能在預防運動傷害的角色。本文整理最近 相關的重要論文，以說明運動視覺研究發展之現況。
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Visual function includes visual acuity, convergence, divergence, accommodation and fusion. Visual functional abnormality leads to eye-strain and life disabilities. The diagnosis of visual functional abnormality depends on visual functional test and so does the treatment accordingly. This article is aimed to discuss the methods of visual function test and the treatments of visual functional abnormality.
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目的：視覺障礙乃導致生活行動不便以及加重社會照護負擔的一大原因。台灣近年較少有文獻整理出視覺障礙人口的盛行率、成因、輔具驗配、以及相關社會福利資源。本研究的目的為整理分析台灣近年視覺障礙相關及低視力輔具資料，並與全球資料做比較。方法：整理台灣內政部視覺障礙的統計資料，並針對全球及台灣近年來相關文獻做回顧分析和比較。結果：台灣從2005年至2015年底因視覺障礙領有殘障手冊的人口增加了7642人，增加比率為15.4%，視覺障礙人口十年來皆以65歲以上的年齡層佔大多數。眼科醫師驗配低視力輔具的流程包含病史詢問、眼睛檢查，輔具驗配及開立處方。結論：台灣近年來視覺障礙患者有增加的趨勢，至2015年底因視覺障礙領有身心障礙手冊的人數為57,319人。視覺障礙成因的第一名是眼睛疾病，又以白內障、視網膜疾病、青光眼為主。視覺障礙不僅會影響患者自身的生活品質、學習及就業，亦會增加社會照護成本及負擔；對於視覺障礙患者，台灣社會提供多元的福利及資源，如社會福利補助、視能復健以及職務再設計等；視覺障礙患者可善用社 會資源，積極尋求協助。
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Purpose: To determine the effect of intraocular lens (IOL) materials on visual outcomes and related complications in patients with posterior capsular (PC) rupture during phacoemulsification surgery. Methods: In this retrospective case-control study, inclusion criteria were PC rupture and primary implantation of acrylic or silicone IOL; while exclusion criteria were pre-existing ocular diseases, previous ocular surgery, intraoperative complications other than PC rupture, and follow-ups less than six months. Main measure outcomes were postoperative best corrected visual acuity (BCVA) at three time points (week 1, month 1, and month 6). Results: PC rupture occurred in 100 out of 2495 patients (4%). After exclusion of three patients, 97 were classified as acrylic (n = 47) or silicone (n = 50) groups by IOL materials, and an additional 45 without PC rupture were selected as a control group. Postoperative BCVA was not different between the acrylic IOL and control groups at all three time points, but it was worse in the silicone IOL group (P＜.01). Stable BCVA was achieved one month postoperatively in the acrylic group, but not until six months in the silicone group. Corneal edema was the most common complication, followed by IOL malposition and intraocular pressure elevation. Complication rate showed no difference between the acrylic and silicone IOL groups (P=.26) but was lower in the control group (P=.03). Conclusion: For phacoemulsification patients who are complicated by PC rupture, faster recovery and better results of BCVA are achieved with acrylic than silicone IOL, while complication rates are similar.
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Purpose: To evaluate the accuracy of ocular emergency triage in an emergency department (ED) in a regional hospital. Method: This retrospective study reviewed the electronic medical records of patients presented to ocular emergency service from Jan. 1 to Jun. 30, 2013. Patients were triaged by the ED duty triage nurses using 5-level Taiwan Triage and Acuity Scale (TTAS) on the spot and were classified into severe and non-severe groups by a senior ophthalmologist based on disease severity afterward. Result: Among 703 enrolled patients, 0%, 11.81%, 84.36%, 3.41% and 0.42% were assigned to TTAS levels 1, 2, 3, 4, and 5, respectively. Severe/non-severe patient numbers were 168/535. Percentage of severity was 56.62%, 19.73%, 16.67% and 0% in levels 2, 3, 4, and 5, respectively. Conclusion: TTAS, developed for general ED patients and not eyededicated, is not an appropriate triage system for ocular emergency patients. To develop a simple & easy-to-use ophthalmic coding system for our ED personnel may be beneficial.
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Purpose: IgG4-related disease (IgG4-RD), a chronic inflammatory disorder, is characterized by a high proportion of IgG4-positive plasma cells in the involved organs, which then causes fibrosis of these organs progressively. The etiology of IgG4-RD remains unclear; however, the possibilities of autoimmune and infectious agents have been hypothesized to trigger this disease. IgG4-RD of orbit (IgG4-ROD) was easily misdiagnosed as other entities. We report a case that was diagnosed as orbital pseudotumor at first, but later proved as IgG-4 ROD by pathological findings. In addition, recurrence at the same location of orbit was found after 15 months follow-up. Method: In this case, we report a male patient who presented with periorbital swelling with a detectable mass of the right eye at his first visit. After totally surgical removal of the orbital mass, the histopathological examination revealed IgG4-related orbital disease (IgG4-ROD). We discuss the associated clinical symptoms, hypothetic etiologies, differential diagnosis, laboratory results, imaging findings, and pathological findings, and treatments. In addition, we review the current literature on IgG4-ROD. Results: The mass was excised completely by using orbital exploration through a transcutaneous incision. The pathological results revealed dense lymphoplasmacytic infiltration, fibrosis, and a high proportion of IgG4-positive plasma cells. IgG4-ROD was diagnosed on the basis of the results of the histopathological examination of the tumor. The symptoms subsided after the mass was removed, and the patient was followed up regularly. But a recurrent orbital mass was found after 1 year of surgery, and mild upper gaze limitation was also noted. Conclusion: Although IgG4-ROD is a disorder diagnosed by pathological findings; it can be differentiated from mimic diseases through laboratory tests and imaging. IgG4-ROD was considered a benign disease; however, a risk of malignancy exists if the pathological findings showed a few reactive lymphoid follicles. Therefore, IgG4-ROD must be differentiated from the other malignant neoplasms.
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Purpose: To report a case with intractable hyphema following Nd:YAG iridotomy in a uremic patient under hemodialysis. Method: An observational case report. Result: A uremic patient without discontinuing aspirin had total hyphema after undergoing Nd:YAG iridotomy. Recurrent bleeding was noted after intracameral injection of tissue plasminogen activator and surgical irrigation. Severe corneal blood staining developed and had a great impact on her vision. Conclusion: Nd:YAG laser peripheral iridotomy may carry the risk of intractable hyphema in uremic patients. Ophthalmologists should be aware of this complication following the procedure.
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Purpose: To report a case with surgical treated conjunctival prolapse following large levator muscle resection. Method: Case report. Result: Here we report a case involving a boy aged 2 years and 10 months who developed conjunctival prolapse 1 week after moderate levator muscle resection of 17 mm for unilateral congenital ptosis. Surgical intervention involving the resection of some prolapsed conjunctiva and anchorage using 8-0 vicryl through the fornix to the skin was successful, with no reccurrence over the 2-year follow-up. Conclusion: Unilateral congenital ptosis may hinder visual development and cause amblyopia in children. Surgical correction is indicated when the visual axis is obscured. Conjunctival prolapse is a rare complication, which can be prevented by limited resection of the levator aponeurosis anterior to the Whitnall’s ligament, meticulous dissection between the aponeurosis and conjunctiva, and application of a transeyelid fixation suture during surgery for ptosis.
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Visual loss after cosmetic blepharoplasty is a rare but devastating complication. There are many possible causes of visual loss following blepharoplasty, with orbital hemorrhage being the most common. We present a case of unilateral permanent visual loss two days after a bilateral upper and lower eyelid blepharoplasty. Central retinal artery occlusion was the main cause of visual loss in the right eye. Blindness as a complication of cosmetic blepharoplasty can be reversible if recognized early and treated properly. Surgeons should bear in mind that there is a potential for visual loss after blepharoplasty. Early consultation with ophthalmologists is mandatory when severe orbital hemorrhage or eyelid swelling occurs.
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Purpose: To present a case of bilateral peripapillary hemorrhage with severe visual loss due to intracranial multifocal anaplastic astrocytoma with chiasmatic involvement. Method: Case report. Result: We present a 58 year-old male patient who suffered with bilateral rapidly visual loss within 1 week. Fundoscope revealed severe bilateral peripapillary hemorrhage and disseminated blot retinal hemorrhage at posterior pole. Brain MRI showed a huge intracranial tumor over bilateral frontoparietal and right temporal lobes, which crossed midline through the corpus callosum. In addition, invasion of optic chiasm and bilateral optic nerve was noted. Brain biopsy by neurosurgeon was performed and anaplastic astrocytoma was proved by histopathology. The patient received a complete course of radiation therapy, which was divided into 32 fractions with total cumulative dose of 6120 centigray. However, he expired 2 months after radiation therapy due to deterioration of general condition. Bilateral peripapillary hemorrhage with severe visual loss secondary to brain anaplastic astrocytoma is an ominous sign with poor clinical outcome, even with aggressive intervention by radiotherapy. Conclusion: In this case report, we show an uncommon case of chiasmatic anaplastic astrocytoma with specific ocular findings as above.