Surgical Outcomes of Epiblepharon Related to Atopic Dermatitis

Purpose@#Patients with atopic dermatitis often have difficulty managing their condition after epiblepharon repair surgery due to edema and itching at the operation site. We examined surgical outcomes in relation to atopic dermatitis. @*Methods@#A retrospective review of medical records was performed on epiblepharon patients and eyelids (patients = 1,829; eyelids = 4,694) that were followed after surgical correction between 2005 and 2016. Patients were classified into those with atopic dermatitis (the atopic dermatitis group) and a control group. Success rates and recurrence rates were compared and analyzed. @*Results@#The mean patient age was 5.82 ± 2.87 years. Of the 200 eyelids with atopic dermatitis, 12 eyelids (6.0%) had undercorrection, as did 108 (2.4%) of the 4,494 eyelids of the control group. Of the 188 eyelids with atopic dermatitis, 13 (6.9%) underwent reoperation due to recurrence, as did 57 (1.3%) of the 4,386 eyelids of the control group. A statistically significant difference between two groups was confirmed in comparing failure rates and recurrence rates (p = 0.002, p < 0.001). @*Conclusions@#The failure rates of surgery and recurrence rates of epiblepharon symptoms were significantly higher in patients with atopic dermatitis. It can be assumed that the suture fixed to the tarsal plate was untied or loosened due to edema and itching of the operation site due to atopic dermatitis. In consideration of this, more effective treatment methods, such as solid suturing, are needed in clinical practice for atopic dermatitis patients.

Effects of Surgical Assistant's Level of Resident Training on Surgical Treatment of Intermittent Exotropia: Operation Time and Surgical Outcomes

PURPOSE: To evaluate the effects of the surgical assistant's level of resident training on operation time and surgical outcome in the surgical treatment of intermittent exotropia. METHODS: This study included 456 patients with intermittent exotropia who underwent lateral rectus recession and medial rectus resection and were followed up for 24 months after surgery. The patients were divided into two groups according to the surgical assistant's level of resident training: group F (surgery assisted by a first-year resident [n = 198]) and group S (surgery assisted by a second-, third-, or fourth-year resident [n = 258]). The operation time and surgical outcomes (postoperative exodeviation and the number of patients who underwent a second operation) were compared between the two groups. RESULTS: The average operation times in groups F and S were 36.54 ± 7.4 and 37.34 ± 9.94 minutes, respectively (p = 0.33). Immediate postoperative exodeviation was higher in group F (0.79 ± 3.82 prism diopters) than in group S (0.38 ± 3.75 prism diopters). However, repeated-measures analysis of variance revealed no significant difference in exodeviation between the two groups during the 24-month follow-up period (p = 0.45). A second operation was performed in 29.3% (58 / 198) of the patients in group F, and in 32.2% (83 / 258) of those in group S (p = 0.51). CONCLUSIONS: No significant difference in operation time was observed when we compared the effects of the level of resident training in the surgical treatment of intermittent exotropia. Although the immediate postoperative exodeviation was higher in patients who had undergone surgery assisted by a first-year resident, the surgical outcome during the 24-month follow-up was not significantly different.

Spontaneous Regression of Lacrimal Sac Squamous Cell Carcinoma

PURPOSE: Spontaneous regression of squamous cell carcinoma is a very rare event. We report a case of primary squamous cell carcinoma in the lacrimal sac which showed spontaneous regression without any treatment. CASE SUMMARY: A 69-year-old woman presented with epiphora and ocular discharge from the right eye. Under the diagnosis of nasolacrimal duct obstruction, we performed dacryocystorhinostomy. Two years after the surgery, the patient presented again with severe epiphora and ocular pain accompanied by proptosis and adduction limitation in the right eye. Computed tomography demonstrated a mass occupying the right lacrimal sac and incisional biopsy showed poorly differentiated invasive squamous cell carcinoma. Additional treatment was recommended, but the patient denied any treatments. At 6 months after the biopsy, the medial orbital wall was partially destructed. On positron emission tomography/computed tomography, metastasis was suspected in the cervical, para-aortic, sub-carinal, and peri-esophageal lymph nodes. However, at 15 months after the biopsy, the orbital tumor had almost disappeared. On positron emission tomography/computed tomography, fluorodeoxyglucose uptake was reduced in all areas including the cervical and mediastinal lymph nodes. CONCLUSIONS: This case exhibited a generally natural course of a malignant tumor, including medial orbital wall destruction and lymph node metastasis. However, the course then improved naturally without any treatment. The reason for the spontaneous regression of squamous cell carcinoma is still unclear but might be due to complex effects of one or several factors.

Intravitreal Dexamethasone Implant for Macular Edema in Branch Retinal Vein Occlusion According to Previous Responses to Bevacizumab

PURPOSE: To compare the efficacy of intravitreal dexamethasone implant according to previous responses to Bevacizumab treatment in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Sixty eyes of 60 patients who received an intravitreal dexamethasone implant for ME secondary to BRVO and followed up for at least 6 months were retrospectively reviewed. Of these, 31 patients were treatment naïve and 29 patients had previously received intravitreal injection of anti-vascular endothelial growth factor (VEGF). Out of these previously-treated patients, 17 patients were categorized as a refractory group who did not respond to previous injection and 12 patients were categorized as a responder group who showed recurrent ME despite a good response to previous anti-VEGF treatment. The best corrected visual acuity (BCVA), central macular thickness (CMT) and recurrence of ME were assessed monthly for 6 months. RESULTS: At each 3-month follow-up, the BCVA improved significantly from baseline in the naïve group, while the refractory group and the responder group showed significant improvement for only 2 months. At each 3-month follow-up, the CMT showed significant decreases in every group. However, the mean change in CMT from baseline showed significant differences between the 3 groups at month 3 (p < 0.001). During follow-up, 18 eyes in the naïve group (58.1%), 16 eyes in the refractory group (94.1%), and 6 eyes in the responder group (50.0%) received retreatment for the recurrence of ME, and there was a significant difference in the retreatment rate between the three groups (p = 0.016). CONCLUSIONS: Intravitreal dexamethasone implant showed early good functional and anatomical improvements irrespective of the response to the previous treatment in patients with ME secondary to BRVO. However, when treating the refractory group, more careful observation and intensive retreatment are required, considering the short duration of its efficacy.