Clinical and Pathological Classification of Eyelid and Conjunctival Tumors: a Retrospective Analysis of Korean Patients

Purpose@#To investigate the clinical and pathological classification of eyelid and conjunctival tumors in Korean patients. @*Methods@#We retrospectively reviewed the medical records of 284 patients with eyelid skin tumors and 158 with conjunctival tumors between January 2011 and June 2020. Demographic, clinical, and histopathological data were analyzed. @*Results@#In total, 260 (91.5%) and 24 (8.5%) patients had benign and premalignant/malignant eyelid tumors, respectively. The mean age was 54.7 ± 20.1 and 72.0 ± 13.5 years, respectively and the most common benign and malignant tumors were intradermal nevus (21.5%) and basal cell carcinoma (4.2%), respectively. The second most common malignant tumor was sebaceous gland carcinoma (1.4%). The conjunctival tumors included 133 (84.2%) benign tumors and 25 (15.8%) premalignant/malignant tumors, in patients with an average age of 47.9 ± 22.2 and 60.7 ± 18.3 years, respectively. The most common benign and malignant conjunctival tumors were subepithelial nevus (13.3%) and lymphoma (10.1%), respectively. The patients with premalignant/ malignant eyelid tumors were significantly older than those with premalignant/malignant conjunctival tumors (p = 0.01). @*Conclusions@#The incidence of sebaceous gland carcinoma was higher in our study than in Western ones, which showed similar results to other East Asian studies. The most common conjunctival malignant tumor was lymphoma in our study and malignant melanoma in Western studies. It is necessary to consider the possibility of lymphoma when the tumor is in the palpebral conjunctiva, where mucosal lymphoid tissue is abundant. This study provides useful data on the incidence and characteristics of eyelid and conjunctival tumors in Korean patients. Further investigations in larger patient populations are required to better understand the epidemiology of eyelid and conjunctival tumors.

Clinical and Pathological Classification of Eyelid and Conjunctival Tumors: a Retrospective Analysis of Korean Patients

Purpose@#To investigate the clinical and pathological classification of eyelid and conjunctival tumors in Korean patients. @*Methods@#We retrospectively reviewed the medical records of 284 patients with eyelid skin tumors and 158 with conjunctival tumors between January 2011 and June 2020. Demographic, clinical, and histopathological data were analyzed. @*Results@#In total, 260 (91.5%) and 24 (8.5%) patients had benign and premalignant/malignant eyelid tumors, respectively. The mean age was 54.7 ± 20.1 and 72.0 ± 13.5 years, respectively and the most common benign and malignant tumors were intradermal nevus (21.5%) and basal cell carcinoma (4.2%), respectively. The second most common malignant tumor was sebaceous gland carcinoma (1.4%). The conjunctival tumors included 133 (84.2%) benign tumors and 25 (15.8%) premalignant/malignant tumors, in patients with an average age of 47.9 ± 22.2 and 60.7 ± 18.3 years, respectively. The most common benign and malignant conjunctival tumors were subepithelial nevus (13.3%) and lymphoma (10.1%), respectively. The patients with premalignant/ malignant eyelid tumors were significantly older than those with premalignant/malignant conjunctival tumors (p = 0.01). @*Conclusions@#The incidence of sebaceous gland carcinoma was higher in our study than in Western ones, which showed similar results to other East Asian studies. The most common conjunctival malignant tumor was lymphoma in our study and malignant melanoma in Western studies. It is necessary to consider the possibility of lymphoma when the tumor is in the palpebral conjunctiva, where mucosal lymphoid tissue is abundant. This study provides useful data on the incidence and characteristics of eyelid and conjunctival tumors in Korean patients. Further investigations in larger patient populations are required to better understand the epidemiology of eyelid and conjunctival tumors.

A Case of Idiopathic Upper Eyelid Swelling Treated by Upper Eyelid Blepharoplasty

PURPOSE: To report a case of idiopathic upper eyelid swelling with minimal response to steroid treatment treated by upper eyelid blepharoplasty. CASE SUMMARY: A 69-year-old man with diabetes mellitus and smoking history, presented upper eyelid swelling in both eyes starting 5 years ago. The patient had been receiving systemic steroid treatment for idiopathic upper eyelid swelling, though each attempt to taper steroid treatment led to recurrence of eyelid swelling. In the initial examination, both upper eyelids showed swelling. For differential diagnosis, a work-up including laboratory test and computerized tomography (CT) scan of the orbit were initiated. There were no abnormalities on laboratory tests including the thyroid function test. A CT scan of the orbit was unremarkable. For managing symptoms and inflammation, smoking was stopped and steroid treatment was administered. The patient still, however, complained of discomfort and swelling. To relieve symptoms and debulk inflammatory tissue, bilateral upper eyelid blepharoplasty was performed. The patient experienced reduced discomfort after the surgery. The biopsy showed no abnormalities, except for mild inflammation. CONCLUSIONS: We present a case of idiopathic upper eyelid swelling despite steroid treatment. In this case, upper eyelid blepharoplasty was used with excellent functional and cosmetic outcomes. Thus, suspension of steroid treatment in cases of patients with recurrent eyelid swelling, in spite of steroid treatment, should be considered.

Clinical Features and Compliance in Patients with Cosmetic Contact Lens-Related Complications

PURPOSE: To investigate the clinical features and compliance of cosmetic contact lens (CL)-related complications compared with soft CL-related complications. METHODS: We performed a retrospective chart review of 97 patients (194 eyes) regarded as having CL-related complications at the outpatient clinic. The portion of complications, gender, age, and chief complaints at the initial visit were analyzed, as was compliance to cosmetic and soft CL-related guidelines for use. RESULTS: A total of 97 patients (49 patients with cosmetic CL-related complications and 43 patients with soft CL-related complications) were evaluated. The mean age of the subjects using cosmetic CL was 19.8 years (14-31 years), and all the patients were female. The chief complaints at the initial visit included ocular pain, injection, blurred vision, dryness, itching and foreign body sensation. The main complications included corneal erosion, sterile corneal infiltrate, allergic disease, neovascularization, corneal ulcer and dry eye syndrome. No statistical difference was found regarding chief complaints or complications. The proportion of patients lost to follow-up was 47% in cosmetic CL-related and 20% in soft CL-related complications, a significant difference (p = 0.015). CONCLUSIONS: Because young females are the most common CL patients and do not always fully comply with the guidelines for use, ophthalmologists need to warn these patients about the risk of serious complications.

Intranasal Procedures for Endonasal Dacryocystorhinostomy

PURPOSE: To describe the rate of surgical intervention to the intranasal structures for making a sufficient bony ostium in endonasal dacryocystorhinostomy. METHODS: Video records of 52 Korean patients (66 eyes) who underwent endonasal dacryocystorhinostomy between January 2010 and December 2010 for primary nasolacrimal duct obstruction were reviewed. To locate the internal common punctum in the lateral nasal wall, a transcanalicular illumination device consisting of disposable vitrectomy light pipe was introduced horizontally through the canaliculus. The relative position of the internal common punctum to the operculum of the middle turbinate was divided into 4 types and analyzed according to the intranasal surgical procedures necessary. RESULTS: Internal common punctum was located posterior-superior to the operculum of the middle turbinate in 37 cases (56%), anterior-superior in 16 cases (24%), posterior-inferior in 11 cases (17%) and anterior-inferior in 2 cases (3%). To expose the bony ostium, partial removal of the operculum of the middle turbinate was required in 63 cases (95%), anterior middle turbinectomy in 43 cases (65%), uncinectomy in 62 cases (94%) and opening of the agger nasi cell in 45 cases (68%). CONCLUSIONS: In a majority of patients, partial removal of the middle turbinate, uncinate process and agger nasi cell were necessary to create a sufficient bony ostium. The transcanalicular illumination device is useful to locate the lacrimal sac and can be helpful in understanding the intranasal structures which need to be removed during surgery.

A Case of Acute Endophthalmitis Following a Dexamethasone Intravitreal Implant

PURPOSE: To report a case of acute endophthalmitis after a dexamethasone (Ozurdex(R)) intravitreal implant for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). CASE SUMMARY: A 63-year-old male patient presented with decreased vision in the right eye due to ME secondary to BRVO. The patient was treated with an intravitreal bevacizumab injection, but ME did not improve. Two months after the injection, dexamethasone (Ozurdex(R)) intravitreal implantation was performed. Four days after the implantation, the patient visited our clinic complaining of severe visual disturbance. Slight conjunctival injection was observed and inflammatory cells and hypopyon were found in the anterior chamber. Fundus was not visible due to vitreous opacity. The patient was presumed to have acute endophthalmitis. Vitrectomy, intravitreal antibiotics injection, dexamethasone implant removal and phacoemulsification were performed. After treatment, the patient's fundus markedly improved, the inflammatory response was controlled and coagulase negative staphylococcus was detected from vitreous culture. CONCLUSIONS: In cases of intravitreal dexamethasone implant associated with acute endophthalmitis, careful examination for diagnosis of endophthalmitis is recommended because the patient may not present with severe ocular pain and injection due to anti-inflammatory effect of corticosteroid.

Thrombocytopenia after Intravitreal Bevacizumab Injection for Macular Edema in Branch Retinal Vein Occlusion

PURPOSE: To report a rare case of thrombocytopenia after intravitreal bevacizumab injection (IVBI) in a patient with macular edema secondary to branch retinal vein occlusion (BRVO). CASE SUMMARY: A 52-year-old female presented to our clinic with complaints of visual disturbance in her right eye for 2 months. She was receiving hemodialysis therapy 3 times a week for 4 years due to chronic renal failure. Unilateral macular edema secondary to BRVO was observed on fundus examination and was confirmed with optical coherence tomography (OCT). The first IVBI was performed, and an additional injection was given 4 weeks later. Four weeks after the second injection, thrombocytopenia was present. The patient was followed up in our clinic without IVBI for 8 weeks and the platelet count recovered. Thrombocytopenia was reconfirmed after 2 additional monthly injections. After she revisited our clinic without IVBI for 8 weeks, the platelet count recovered without any treatment. CONCLUSIONS: When a patient presents with thrombocytopenia after IVBI with macular edema in BRVO, thrombocytopenia due to IVBI should be considered as a possible diagnosis.

Changes in Corneal Topography after 23-Gauge Transconjunctival Vitrectomy

PURPOSE: To evaluate the postoperative corneal topographic changes after 23-gauge transconjunctival vitrectomy. METHODS: Twenty eyes of 20 consecutive patients who required vitrectomy were included in the present study. The 23-gauge transconjunctival vitrectomy was performed by a single surgeon from September 2007 through November 2007. Videokeratography system (TMS-4, Tomey Co., Japan) was obtained preoperatively and at 1 day, 2 weeks, and 1 month postoperatively. The date changes of Fourier indices including spherical power, regular astigmatism, asymmetry, and higher-order irregularity were analyzed at the central 3- and 6-mm zone of the cornea. RESULTS: Twenty eyes, including eyes with proliferative diabetic retinopathy (n = 9), vitreous hemorrhage and opacity (n = 7), and epiretinal membrane (n = 4), underwent the operation. None of the Fourier indices significantly changed throughout the observation period (p < 0.05, Wilcoxon-signed-ranks test). CONCLUSIONS: A 23-gauge transconjunctival vitrectomy does not induce significant changes in corneal topography even in the central 6-mm zone, as well as the 3-mm zone of the cornea.

Changes in Corneal Topography after 23-Gauge Transconjunctival Vitrectomy

PURPOSE: To evaluate the postoperative corneal topographic changes after 23-gauge transconjunctival vitrectomy. METHODS: Twenty eyes of 20 consecutive patients who required vitrectomy were included in the present study. The 23-gauge transconjunctival vitrectomy was performed by a single surgeon from September 2007 through November 2007. Videokeratography system (TMS-4, Tomey Co., Japan) was obtained preoperatively and at 1 day, 2 weeks, and 1 month postoperatively. The date changes of Fourier indices including spherical power, regular astigmatism, asymmetry, and higher-order irregularity were analyzed at the central 3- and 6-mm zone of the cornea. RESULTS: Twenty eyes, including eyes with proliferative diabetic retinopathy (n = 9), vitreous hemorrhage and opacity (n = 7), and epiretinal membrane (n = 4), underwent the operation. None of the Fourier indices significantly changed throughout the observation period (p < 0.05, Wilcoxon-signed-ranks test). CONCLUSIONS: A 23-gauge transconjunctival vitrectomy does not induce significant changes in corneal topography even in the central 6-mm zone, as well as the 3-mm zone of the cornea.

A Case of IgG4-Related Sclerosing Disease Involving the Optic Nerve

PURPOSE: To report a case of IgG4-related sclerosing dacryoadenitis masquerading for a long period as a. CASE SUMMARY: A 59-year-old man with visual acuity loss and proptosis in the left eye was referred to our hospital. Ten years prior, the patient was diagnosed with lymphoma and underwent chemotherapy at another hospital. However, the patient spontaneously stopped treatment and took steroids for the relief of periorbital swelling. Magnetic resonance imaging revealed diffuse infiltrative lesions involving both optic nerves and extraocular muscles. Incisional biopsies of the lacrimal gland's posterior side and the lateral rectus muscle's lateral side were performed. Staining for IgG4 via immunochemistry showed infiltration of IgG4-positive lymphoplasmacytic cells. Under the diagnosis of IgG4-related sclerosing disease, the patient underwent high-dose steroid pulse therapy.

A Case of IgG4-Related Sclerosing Disease Involving the Optic Nerve

PURPOSE: To report a case of IgG4-related sclerosing dacryoadenitis masquerading for a long period as a. CASE SUMMARY: A 59-year-old man with visual acuity loss and proptosis in the left eye was referred to our hospital. Ten years prior, the patient was diagnosed with lymphoma and underwent chemotherapy at another hospital. However, the patient spontaneously stopped treatment and took steroids for the relief of periorbital swelling. Magnetic resonance imaging revealed diffuse infiltrative lesions involving both optic nerves and extraocular muscles. Incisional biopsies of the lacrimal gland's posterior side and the lateral rectus muscle's lateral side were performed. Staining for IgG4 via immunochemistry showed infiltration of IgG4-positive lymphoplasmacytic cells. Under the diagnosis of IgG4-related sclerosing disease, the patient underwent high-dose steroid pulse therapy.

Changes in Higher Order Aberration After Implantable Contact Lens Implantation

PURPOSE: To evaluate the changes in higher-order aberrations (HOAs) after implantation of an ICL (implantable contact lens). METHODS: Twenty-six eyes that had undergone ICL implantation between February 2008 and October 2009 were included. Ocular higher-order aberrations of all the eyes were measured using the Hartmann-Shack aberrometer (KR9000PW). Examinations were performed preoperatively, as well as one week, one month, and three months after ICL implantation. Changes in ocular total higher-order aberrations, total spherical aberration, coma aberration, trefoil aberration, and S3 and S4 calculated in the central 4-mm zone and expressed as root mean square (RMS) values were analyzed. RESULTS: The mean patient age was 25.4 years, and the mean preoperative spherical equivalent was -6.40 diopters(D). The mean postoperative spherical equivalents were 0.00 +/- 0.13D, 0.03 +/- 0.21D, -0.013 +/- 0.12D at one week, one month,and three months, respectively. There were no statistically significant differences in ocular higher-order aberration RMS,including spherical, coma, or trefoil aberration, at one week, one month, or three months postoperative or between preoperative and postoperative measurements. CONCLUSIONS: There is no significant change of ocular higher order aberration in the central 4-mm zone after ICL implantation.

Comparison of Aberrations in Korean Normal Eyes Measured With Two Different Aberrometers

PURPOSE: To compare ocular higher order aberrations measured by two different aberrometers in a sample of normal eyes. METHODS: We included 41 normal eyes of Koreans in this study. Ocular aberration data were obtained through three measurements per eye using Zywave and OPD-Scan devices. Spherical equivalent and higher order aberrations calculated in the central 6 mm zone and expressed as root mean square (RMS) values were analyzed. RESULTS: A comparison of measurements between the Zywave and OPD-Scan devices demonstrated no statistically significant differences in the RMS values of total higher order aberration (p=0.11), but significant differences were detected in the RMS values of total spherical aberration, total coma and total trefoil (p<0.01). CONCLUSIONS: The two different aberrometers that we tested are suitable for taking repeated measurements and are internally consistent, but not interchangeable.

A Case Report of Fungal Keratitis Diagnosed by Femtosecond Laser Assisted Corneal Biopsy

PURPOSE: To describe femtosecond laser-assisted corneal biopsy and its use in assessing the causative organism in a case of fungal keratitis that occurred 8 months after penetrating keratoplasty. CASE SUMMARY: A 27-year-old man who had undergone penetrating keratoplasty 8 months prior showed atypical diffuse corneal haze and erosion. Diagnostic corneal biopsy using a femtosecond laser was performed because of repeated negative test results for an infectious organism and a lack of improvement, despite steroid and empirical antibiotic therapy. A corneal flap 200 micrometer in depth and 3 mm in diameter was obtained. The biopsy showed pseudohyphae, which led to a diagnosis of Candidal keratitis. No complications occurred during the procedure. CONCLUSIONS: Femtosecond laser-assisted corneal biopsy enabled identification of the infectious pathogen. This technique is easy, safe, and rapid, and it yields a biopsy specimen with a uniform depth and precise size. Femtosecond laser-assisted corneal biopsy can be used as an accurate diagnostic method in uncertain cases of corneal ulcers.