Seung-Hyun Kim

Purpose: To evaluate the effectiveness of 0.125% atropine eye drops in controlling myopia progression by analyzing 1-year follow-up data through a multicenter retrospective study in South Korea.Methods: A retrospective chart review was conducted across five centers, including 121 myopic children (aged 4–11 years) treated with 0.125% atropine between January 2021 and December 2023. An equal number of age-, sex-, axial length (AL)-, and spherical equivalent (SE)-matched untreated individuals (control group) were included. Baseline and follow-up data at 6 and 12 months included visual acuity, autorefraction, AL measurement (IOLMaster 700), and fundus examination. The primary outcome measures were changes in SE and AL compared to controls.Results: Age, SE, and AL in the treatment group at baseline were 7.5 ± 1.5 years (range, 4 to 11), –3.07 ± 1.65 diopters (D; range, –0.25 to –5.88 D), and 24.39 ± 0.85 mm (range, 22.19 to 26.94 mm), respectively, and these parameters showed no statistical differences compared to the matched controls. SE after 1-year treatment was less myopic in the treatment group (–3.42 ± 1.72 D vs. –3.94 ± 1.92 D, p = 0.019). Similarly, AL was significantly shorter in treatment group compared to the control group (24.65 ± 0.88 mm vs. 24.88 ± 0.80 mm, p = 0.031). The SE change from baseline was –0.33 ± 0.73 D in the treatment group versus –0.91 ± 1.01 D in the control group (p < 0.001). AL increased by 0.25 ± 0.32 mm in the treatment group, significantly less than 0.49 ± 0.24 mm increase in the control group (p < 0.001). Baseline AL and mean keratometry showed no correlation with AL progression (all p > 0.05).Conclusions: The use of 0.125% atropine eye drops significantly reduced myopia progression, with approximately 50% reduction in AL elongation compared to controls. Given its effectiveness and variable compliance, 0.125% atropine eye drops may serve as a viable alternative to low-dose atropine for myopia control.

Despite extensive research on clinical characteristics, patient management, and surgical outcomes of intermittent exotropia, there remains significant confusion regarding the nomenclature system for infantile exotropia, which develops before 12 months of age. Additionally, there still is a controversy over whether infantile exotropia represents the phenotypic counterpart of infantile esotropia or early-onset intermittent exotropia. In this article, we critically review the previous nomenclature systems and propose some modifications to the current classifications of infantile exotropia. These include three diagnostic categories: 1) primary infantile exotropia 2) early-onset intermittent exotropia and 3) secondary infantile exotropia. Stereopsis is valuable for differentiation between primary infantile exotropia and early-onset intermittent exotropia. However, further research is needed for more precise descriptions of their clinical features, optimal surgical timing, and proper management.

Background/Objectives: Asthma, a chronic airway inflammatory disease characterized by bronchial narrowing and caused by an inflammatory response, results in airway obstruction and hyperresponsiveness. Stachydrine (STA), an abundant metabolite found in plants and humans, is recognized for its bioactivity in treating fibrosis, cancer, and inflammation. However, its effects on asthma have not been fully elucidated. We aimed to investigate the ameliorating effects of STA on chronic airway inflammation caused by Dermatophagoides pteronyssinus (house dust mite, HDM). Methods: We used a murine model of HDM-induced airway inflammation to assess the change in metabolite profile by chronic airway inflammation. The mice were challenged with HDM (35 challenges in total) for up to 12 weeks. Serum metabolites were analyzed using capillary electrophoresis time-of-flight mass spectrometry. Results: HDM exposure increased airway hypersensitivity, immune cell infiltration, cytokine production, goblet cell hyperplasia, collagen deposition, and alpha smooth muscle actin and fibronectin expression. Serum metabolite analysis revealed that STA levels were lower in the mice with HDM-induced chronic inflammation than in the controls. In vitro analyses demonstrated that HDM sensitization increased cytokine production (interleukin [IL]-6 and IL-8) and extracellular signal-regulated kinase (ERK) activity. However, STA treatment reduced HDM-induced IL-6 and IL-8 production and ERK activity. Co-treatment with a mitogen-activated protein kinase (MAPK) inhibitor and STA resulted in a more pronounced reduction in cytokine production and MAPK activity. Conclusions: These findings suggest that STA, particularly when used in combination with a MAPK inhibitor, effectively suppresses airway inflammation through ERK pathway inhibition, making it a potential therapeutic agent for asthma treatment.

Purpose: To analyze the chief complaints and clinical characteristics of patients with intermittent exotropia who voluntarily revisited our clinic more than 3 years after stabilization of bilateral lateral rectus recession.Methods: This study retrospectively reviewed the medical records of patients diagnosed with intermittent exotropia who underwent bilateral lateral rectus recession and revisited the outpatient clinic after more than 3 years of follow-up.Results: Thirty-two patients were included. The most common reason for voluntary revisit was suspicion of recurrence (n = 21, 65.6%). Reasons for revisit were divided into suspicion of recurrence (exodrift group) and others (no exodrift group). At the revisits, both the distance and near deviation angles of the exodrift group were larger than those of the no exodrift group. For all patients and the exodrift group, both the distance and near deviation angles were higher at the revisits than at the last follow-up visits. For both groups, the near stereoacuity did not differ between the last follow-up visit and the revisit but the spherical equivalent was more myopic at the revisit than the last follow-up visit in all eyes except the left eyes of the no exodrift group. The deviation angles of 11 patients who underwent continuous follow-up after the revisits did not significantly change over 1 year after full correction of the refractive error, with the exception of 1 who underwent re-operation.Conclusions: When patients stabilize after intermittent exotropia surgery, the decrease in the corrected visual acuity triggers fusional convergence deterioration and, in turn, unstable strabismus. However, after full correction of the refractive error, the deviation angle stabilizes without further progression. It is important to explain this to patients/guardians at the end of initial follow-up.

Purpose: To evaluate the surgical outcomes of a modified normogram for bilateral lateral rectus recession in the surgical management of intermittent exotropia, with a focus on achieving small overcorrection.Methods: A retrospective medical chart review of 242 patients who underwent surgery for intermittent exotropia between October 2014 and June 2020 was performed. Our modified normogram reducing amount of recession targeted for small postoperative overcorrection within 5 prism diopters (PD). Patients were observed for at least 3 years. Esodeviation was denoted by negative numbers and positive values indicated exodeviation. A satisfactory outcome was defined as if distant angle of deviation ranged between ≤10 PD of exotropia and ≤5 PD of esotropia. Recurrence was defined as an exodeviation of >10 PD at distance. Overcorrection was defined as an esodeviation of >5 PD at distance.Results: The mean preoperative deviation angles were 29.32 ± 3.92 PD at distance and 29.88 ± 4.41 PD at near. At postoperative day 1, the mean deviation angles at distance and near were –6.22 ± 1.44 and –6.22 ± 1.49 PD, respectively. Overcorrection within 6 PD of esodeviation was seen in 168 patients (69.42%), undercorrection with exophoria was noted in 11 patients (4.55%), and overcorrection by more than 6 PD of esodeviation was seen in 63 patients (26.03%) at postoperative day 1. The long-term success rate at postoperative 3 years was 77.27% (187 of 242), with a recurrence rate of 19.83% (48 of 242) and an overcorrection rate of 2.89% (7 of 242). A positive correlation between the angle of deviation at postoperative day 1 and 3 years was observed (r = 0.22, p = 0.001). The final success rate at the final examination after a mean follow-up of 38.60 ± 7.99 months was 83.06%.Conclusions: Our modified normogram for bilateral lateral rectus recession in intermittent exotropia surgery resulted in successful surgical outcomes with small overcorrection, reducing the risk of consecutive esotropia due to excessive overcorrection.

Purpose To evaluate the effectiveness of “Simple distant look test” with Polarized glasses in detecting suppression in patients with intermittent exotropiaMethods This prospective study was performed in patients with basic-type intermittent exotropia greater than 10 prism diopters (PD) at distance (6m) and near (33cm). Vectographic projector test (L29; Luneau Technology, Luneau, France) was used for distant suppression measurement. Positive “Simple distant look test” was defined as constant exodeviation of one eye at distance (6m). Sensitivity, specificity, positive predictive value, and negative predictive value were analyzed (GraphPad Prism® software, Inc., La Jolla, CA, USA).Results 60 patients were included, 40 patients with suppression and 20 patients without suppression. Mean angle of deviation was 20.2 ± 6.0 PD at distance and 20.3 ± 6.0 PD at near. The sensitivity of the test was 100%, the specificity was 95%, positive predictive value was 97.56% and negative predictive value was 100%.Conclusion Due to its simplicity and accuracy, the "Simple distance loot test” could be an alternative to other suppression tests and can be applied to a wide range of age groups.

Purpose: To compare the long-term clinical outcomes of patients with refractive accommodative esotropia (RAET) and infantile esotropia (IET). Methods: The medical records of patients with RAET and IET who were followed-up for more than 36 months were retrospectively analyzed. The RAET patients were prescribed spectacles to correct cycloplegic refraction and those with IET underwent bilateral, medial rectus recession. Visual acuity, refraction, the angle of esodeviation at far and near distances, and near-stereopsis were measured at each visit. The IET patients were divided into two groups by the time of surgery (before and after 24 months of age). Patients in both groups who underwent reoperations after diagnosis of partially accommodative esotropia (PAET) and recurrent IET during follow-up were analyzed. Results: Sixty-nine patients (40 with RAET and 29 with IET) were included. The follow-up period was 69.48 ± 28.41 months. At the final visit, the angles of esodeviation were 2.82 ± 5.46 prism diopters (PD) in the RAET group and 9.28 ± 8.37 PD in the IET group (p < 0.01). In IET patients who underwent surgery before and after 24 months of age, the angles of esodeviation were 4.62 ± 5.25 and 13.06 ± 8.63 PD and the median near-stereopsis values 60 and 140 arcsec at the final visit (p < 0.01, 0.03). Seven patients (17.5%) in the RAET group, and 2 (15.4%) and 10 (62.5%) IET patients who underwent surgery before and after 24 months of age, required reoperations (p < 0.01). Conclusions: RAET and IET patients who underwent surgery before 24 months of age exhibited better alignment and stereopsis at the final visit than those who underwent later surgery and the reoperation rate was lower.

Purpose: To evaluate the extent to which myopia correction decreases distant exodeviation in patients with intermittent exotropia (IXT) and myopia. Methods: The medical records of patients with IXT who underwent myopia correction without surgical intervention were retrospectively reviewed. No patient evidenced anisometropia or amblyopia; all exhibited distant angles of deviation greater than 10 prism diopters (PD). The refractive errors of the eye with greater myopia were analyzed. Patients who underwent at least 3 months of follow-up were included. We recorded age, sex, the angle of deviation, the stereoacuity, and suppression status. Patients who did and did not evidence improvement were analyzed at 9 months in terms of change in the distant angle of deviation. Results: A total of 30 patients were analyzed. The average age was 8.27 ± 2.59 years. There were 18 (60%) males and 12 (40%) females. Twenty-four (80%) exhibited statistically significant decreases in the distant angle of deviation after wearing glasses for 3 months; the average value was 5.54 ± 3.59 PD (range 2-16 PD) (p < 0.001). We found no significant decrease from 3 months to > 9 months (1.17 ± 3.63 PD) (p = 0.129). In patients evidencing no improvement at 3 months, we found no significant change in the distant angle of deviation at either 3 months (3.00 ± 4.56 PD) (p = 0.102) or 9 months (-3.66 ± 4.41 PD) (p = 0.132). Conclusions: Eighty percent of IXT patients with myopia exhibited significant decreases in the distant angle of deviation after wearing glasses for 3 months, and this was well-maintained after 9 months.

Purpose: To evaluate the effect of classroom illuminance on the development and progression of myopia in elementary school children.Methods: The daylight factor, a ratio of inside and outside illuminance, was obtained in 50 elementary schools. The firstgrade students in the school with the lowest daylight (LD) factor (LD school, 145 subjects; 0.51%) and with the highest daylight (HD) factor (HD school, 147 subjects; 13.35%) were selected. A survey was conducted to evaluate parental myopia, the amount of near-work and outdoor activities. The refractive error and axial length (AL) were measured at initial and after 6 months. The spherical equivalent, AL, and the survey results were compared between the two schools. The mean AL of the emmetropic children was obtained, and all subjects were divided into two groups, more and less than mean AL. Changes in refractive errors and AL were also compared according to AL.Results: The amount of change in spherical equivalent and AL after 6 months were not different between the two schools. Initial prevalence of myopia was high in the HD school. However, it became similar between the two schools after 6 months. The mean AL of 155 emmetropic children was 22.7 ± 0.63 mm. In the 185 children with AL ≥22.7 mm, there was no difference in the AL change between the two schools. However, the change in AL in 107 children with AL <22.7 mm was significantly larger in the LD school (0.19 mm) than that in the HD school (0.15 mm, p = 0.049). Parental myopia, near-work and outdoor activities were not different between the two schools.Conclusions: High classroom illuminance during the day reduced axial elongation in eyes of children with a shorter AL. Increase in classroom light level by permitting more sunlight can be a protective measure against the development of myopia.