Corneal Topographic Changes after Botulinum Toxin-A Injection in Patients with Essential Blepharospasm

Purpose@#To compare the corneal topographic change before and after botulinum toxin A injection in patients with essential blepharospasm. @*Methods@#From September 2015 to December 2020, we enrolled total 20 patients, 40 eyes diagnosed with essential blepharospasm. We estimated the corneal refractive power and astigmatism before and after Nabota® (Daewoong Co. Ltd, Seoul, Korea) botulinum toxin injection at 1 and 3 months using iTrace® Topography (Software version 4.2.1., Tracey technology Inc., Houston, TX, USA). Corneal refractive power was analyzed in superior, inferior, nasal and temporal location at 1 mm, 3 mm zone. Also, steep and flat keratometry, astigmatism was measured by topography. @*Results@#Corneal refractive power showed significant difference in superior and inferior location of 1 mm zone at 1 month after botulinum toxin injection (p = 0.038, p = 0.042). There was no significant difference in all four locations of 3 mm zone. At 1 month after toxin injection, steep keratometry was only significant reduced (p = 0.046) and with-the-rule astigmatism was shifted to against-the-rule astigmatism. At 3 months after toxin injection, keratometry and astigmatism was resolved to before toxin injection. @*Conclusions@#At 1 month after Nabota® (Daewoong Co. Ltd) botulinum toxin injection, corneal refractive power at vertical axis was flattened and steep keratometry was significantly reduced. At 3 months after toxin injection, corneal topographic change was changed to before toxin injection.

Analysis of Office Probing in Children Under 4 Years of Age with Congenital Nasolacrimal Duct Obstruction

Purpose@#To analyze the effect of office-based probing in different age groups of children with congenital nasolacrimal duct obstruction. @*Methods@#A retrospective study was conducted in 146 children (200 eyes) diagnosed with congenital nasolacrimal duct obstruction who underwent office-based probing. The children were classified into four groups at the time of probing: group A ( 6 months but 12 months but 20 months but < 48 months). Age at the time of the procedure, gender, laterality, follow-up period, clinical symptoms, and the number of probings were investigated. Success rates were compared among the four groups in terms of sex, age, laterality, and the number of probings. @*Results@#The success rate of the first probing was 160/200 eyes (80.0%). The success rates were 87.5% in group A, 85.7% in group B, 77.6% in group C, and 76.7% in group D. No significant difference in the success rate was observed according to age (p = 0.550). The second probing was performed in 40 eyes. The success rates were 100% in group A, 87.5% in group B, 70.6% in group C, and 35.7% in group D. A significant difference in the success rate was observed according to age (p = 0.048). The success rate of the second probing was 25/40 eyes (62.5%). No significant difference in laterality was observed among the four groups (p = 0.291). @*Conclusions@#No significant difference in the success rate of first nasolacrimal duct probing was detected, but a significant difference in the success rate of the second probing was detected according to age in children < 4 years of age.

Analysis of Office Probing in Children Under 4 Years of Age with Congenital Nasolacrimal Duct Obstruction

Purpose@#To analyze the effect of office-based probing in different age groups of children with congenital nasolacrimal duct obstruction. @*Methods@#A retrospective study was conducted in 146 children (200 eyes) diagnosed with congenital nasolacrimal duct obstruction who underwent office-based probing. The children were classified into four groups at the time of probing: group A ( 6 months but 12 months but 20 months but < 48 months). Age at the time of the procedure, gender, laterality, follow-up period, clinical symptoms, and the number of probings were investigated. Success rates were compared among the four groups in terms of sex, age, laterality, and the number of probings. @*Results@#The success rate of the first probing was 160/200 eyes (80.0%). The success rates were 87.5% in group A, 85.7% in group B, 77.6% in group C, and 76.7% in group D. No significant difference in the success rate was observed according to age (p = 0.550). The second probing was performed in 40 eyes. The success rates were 100% in group A, 87.5% in group B, 70.6% in group C, and 35.7% in group D. A significant difference in the success rate was observed according to age (p = 0.048). The success rate of the second probing was 25/40 eyes (62.5%). No significant difference in laterality was observed among the four groups (p = 0.291). @*Conclusions@#No significant difference in the success rate of first nasolacrimal duct probing was detected, but a significant difference in the success rate of the second probing was detected according to age in children < 4 years of age.

Comparision of Patient Characteristics in Graves’ Ophthalmopathy with and without Strabismus Surgery

Purpose@#To evaluate the clinical and radiological differences between the strabismus surgery and non-surgery groups in patients with Graves' ophthalmopathy. @*Methods@#From January 2009 to January 2019, 20 patients who underwent strabismus surgery and 225 patients who did not undergo strabismus surgery were retrospectively analyzed using medical records. The mean age of the patients, the presence of smoking, the presence of hypertension and diabetes mellitus, anti-thyroid peroxidase antibody levels, anti-thyroglobulin antibody levels, thyroid stimulating hormone (TSH) receptor antibody levels, the presence of steroid therapy, the presence of radiation therapy, soft tissue scores, clinical activity scores (CASs), using methimazole, the presence of exophthalmos, and the maximal cross-sectional areas of the inferior and medial rectus muscles using computed tomography (CT) were compared between the two groups. @*Results@#There was no statistically significant difference in sex, smoking, the presence of hypertension and diabetic mellitus, anti- thyroid peroxidase antibody levels, anti-thyroglobulin antibody levels, steroid therapy, radiation therapy, soft tissue scores, CASs, using methimazole, and the presence of exophthalmos between the strabimus surgery and non-surgery groups (p = 0.472, p = 0.523, p = 0.537, p = 0.751, p = 0.107, p = 0.195, p = 0.320, p = 0.071, p = 0.562, p = 0.144, p = 0.663, and p = 0.423, respectively). The mean age of the patients, TSH receptor antibody levels, and the averages of the maximal cross-sectional areas in the medial and inferior rectus muscles were significantly different between the two groups (p = 0.034, p = 0.042, p = 0.001, and p = 0.038, respectively). @*Conclusions@#In patients with Graves’ ophthalmopathy, the risk factors for ocular motility disorders requiring strabismus surgery were not significant except for age, TSH receptor antibody levels, and the average of the maximal cross-sectional areas in inferior and medial rectus muscles using a CT scan.

Anti-staphylococcal Effect of a Nephrite-containing Contact Lens Storage Case

Purpose@#To compare the anti-staphylococcal effect of nephrite-containing contact lens (CL) storage cases and conventional CLstorage cases.Method: The degree of proliferation and adhesion of Staphylococcus aureus (S. aureus) on first- to third-generation silicone hydrogelcontact lenses (SHCLs) was analyzed through comparison of 5% nephrite-containing CL storage cases and conventionalCL storage cases. The degree of adhesion of S. aureus to the CL was also compared between 1% or 5% nephrite solution andmultipurpose solution (MPS).Result: Nephrite-containing CL storage cases showed a significant inhibitory effect on S. aureus proliferation (p = 0.004) and significantlyreduced the number of adherent S. aureus on all first- to third generation SHCLs compared with conventional CL storagecases (p = 0.026, p = 0.043, and p = 0.001, respectively). The anti-staphylococcal effect of 1% and 5% nephrite solutionswas not significantly better than that of MPS. @*Conclusions@#Nephrite shows potential as a next-generation substance for reducing infectious keratitis caused by S. aureuswhen added to CL storage cases.

Two Cases of Periorbital Necrotizing Fasciitis in Immunocompromised Patients

Purpose@#To report two cases of periorbital necrotizing fasciitis in immunocompromised patients.Case Summary: (Case 1) A 55-year-old female with a history of diabetes and hepatic liver resection visited our clinic complainingof periorbital edema in her left eye 4 days prior to her visit. The visual acuity of the left eye was no light perception.Erythematous edema of the periorbital area and a black necrotic lesion in the left eye were observed. Periorbital necrotizing fasciitiswas diagnosed and broad-spectrum antibiotics were injected. Urgent debridement was recommended but the patient wentto another hospital and orbital exenteration was performed. K. pneumoniae was isolated in her blood culture. (Case 2) A56-year-old female with a history of ovarian cancer chemotherapy visited our clinic complaining of periorbital pain and skin necrosisin her right eye 3 days prior to her visit. The visual acuity of the right eye could not be measured because of severe lidedema. Periorbital necrotizing fasciitis was diagnosed and antibiotic injection and urgent debridement were performed. P. aeruginosawas isolated in her blood culture. Postoperative infection progression and recurrence were not observed and eyelid reconstructionwas performed. @*Conclusions@#Early detection and treatment of periorbital necrotizing fasciitis is important in immunocompromised patients.Proper antibiotic therapy and necrotic debridement are needed to remove the periorbital inflammation.

Clinical Outcomes of Patients Implanted with Bifocal and Extended Depth of Focus Intraocular Lenses

PURPOSE: To compare the postoperative clinical outcomes after cataract surgery with implantation of bifocal intraocular lenses (IOLs) and extended depth of focus (EDOF) IOLs. METHODS: A total of 60 patients were divided into three groups, and each group included 20 patients of 40 eyes: group A with a +3.25 D bifocal IOL in both eyes, group B with an EDOF IOL in both eyes, and group C with a +3.25 D bifocal in one eye and an EDOF IOL in the other eye. We retrospectively reviewed the patients' medical charts to analyze their binocular uncorrected visual acuities (UCVAs; distant, intermediate, and near) and refraction at postoperative 3 months. RESULTS: The binocular distant UCVAs were 0.04 ± 0.01, 0.05 ± 0.02, and 0.04 ± 0.01 in groups A, B, and C, respectively, and there were no differences between the groups (p > 0.05). The intermediate UCVAs were 0.16 ± 0.01, 0.10 ± 0.01, and 0.10 ± 0.01, respectively, and group A was the lowest (A–B, p = 0.031; A–C, p = 0.018; B–C, p = 1.000). The near UCVAs were 0.05 ± 0.01, 0.24 ± 0.01, and 0.13 ± 0.01, respectively, and there were significant differences between the groups (A–B, p < 0.001, A–C: p = 0.009; B–C, p = 0.003). CONCLUSIONS: There were no significant differences among the three groups in binocular distant UCVA, and groups B and C showed better intermediate UCVAs than group A. Near UCVA was ranked in the order of groups A, C, B.

Primary Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue of the Lacrimal Sac Mimicking Dacryocystitis

PURPOSE: We report a case of a young female patient who was diagnosed with a marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT lymphoma) of the lacrimal sac which mimicked dacrocystitis. CASE SUMMARY: A 23-year-old female suffered from epiphora for 3 years in the right eye. She had swelling and a painful lesion at the lacrimal sac 4 months prior and was referred to our hospital due to nasolacrimal duct obstruction and dacryocystitis. Lacrimal irrigation was performed with no passing and regurgitation with mucoid discharge. We performed orbital computed tomography and magnetic resonance imaging which showed a suspected tumor of the lacrimal sac in the right eye. We then performed excision and biopsy of the tumor through the skin approach. The patient was diagnosed with a MALT lymphoma with no systemic involvement. After six cycles of chemotherapy involving rituximab with cyclophosphamide, vincristine, and prednisone, the lesion of the mass and the painful symptoms decreased, which was regarded as a complete response. However, epiphora and eye discharge persisted, showing a nasolacrimal duct obstruction, so we performed endoscopic dacryocystorhinostomy with a lacrimal sac biopsy. The histological examination showed chronic inflammation, but not lymphoma. There was no recurrence of lymphoma at one year postoperatively. CONCLUSIONS: If there is an epiphora and palpable lesion in the lacrimal sac area, MALT lymphoma mimicking dacyocystitis may be suspected. After the lymphoma is first diagnosed by excision and biopsy, systemic chemotherapy with dacryocystorhinostomy could be an effective treatment.

Frontotemporal Dermoid Cyst with Sinus Tract in a Child

PURPOSE: To report the treatment results of a frontotemporal dermoid cyst with a cutaneous fistula and sinus tract that caused recurrent periorbital cellulitis in a child. CASE SUMMARY: A 4-year-old girl who presented with left orbital swelling and tenderness visited our hospital. She had a cutaneous fistula with a small amount of purulent discharge at the left frontotemporal area. Orbital computed tomography scans showed a well-defined low density lesion in the fronto-zygomatic suture, and there was a bony defect in the left greater wing of the sphenoid bone of the orbit. Orbital magnetic resonance imaging showed a cutaneous fistula and sinus tract that extended into the middle cranial fossa. The patient was treated with intravenous antibiotics until the inflammation was resolved. Surgery was performed to remove the dermoid cyst with sinus tract. After surgery, there was no evidence of recurrence, and complications included neurologic and ophthalmic symptoms. CONCLUSIONS: Orbitofacial lesions, particularly frontotemporal cutaneous fistulas that present with recurrent discharge, should be regarded with suspicion in cases of deep extended dermoid cysts with sinus tract. Additionally, imaging tests should be carefully conducted before surgery.

Comparison of Results and Complications between 0.64 mm and 0.94 mm Silicone Tube Intubation in Adults

PURPOSE: To compare surgical success rates and complications of silicone tube intubation using 0.64-mm- and 0.94-mm-diameter tubes in adult patients with nasolacrimal duct stenosis. METHODS: In 62 eyes of 36 patients diagnosed with nasolacrimal duct stenosis who had undergone silicone tube intubation, we surveyed sex, age, symptom duration, time of tube removal, mean follow-up period, and surgical success rate between two groups divided by silicone tube diameter, 0.64 mm and 0.94 mm. By preoperative syringing test and dacryocystography, we examined the surgical results and complications of the two groups. RESULTS: The silicone tube diameter was 0.64 mm in 43 eyes (69.4%) and 0.94 mm in 19 eyes (30.2%). The surgical success rates in the two groups were 84.1% (36 eyes) and 78.9% (15 eyes), respectively, but the difference was not significant statistically. The surgical success rate was higher in partial stenosis than in complete stenosis but was not different according to silicone tube diameter according to preoperative syringing test and dacryocystography. Silicone tube disconnection and bending were only observed in 0.94-mm-diameter silicone tubes. CONCLUSIONS: In silicone tube intubation for nasolacrimal duct stenosis in adults, silicone tube diameter does not affect operation success. However, silicone tube disconnection and bending were observed only in the 0.94 mm silicone tube.

Double Fold Affected by Levator Function in Simultaneous Double Eyelid Blepharoplasty with Blepharoptosis Surgery

PURPOSE: To evaluate height and symmetry of double folds following simultaneous levator palpebral muscle resection and double eyelid blepharoplasty for correction of blepharoptosis. METHODS: We retrospectively studied 400 eyes of 286 patients who underwent simultaneous surgeries for double eyelid construction and correction of blepharoptosis from January 2006 to December 2011. All the patients were divided into three groups based on levator palpebrae muscle function: group A consisted of 82 eyes whose Levator Function Test (LFT) was 5 cm or less, group B consisted of 115 eyes whose LFT was between 5 and 10 cm, group C consisted of 203 eyes whose LFT was over 10 cm. For each group, we evaluated the preoperative marginal reflex distance 1 (MRD1), surgical methods, the postoperative height and symmetry of the double folds, and additional operations for correcting blepharoptosis. RESULTS: Blepharoptosis surgery was performed in all groups by simultaneous levator resection and double eyelid blepharoplasty in all groups. Postoperative asymmetric double fold was the most common outcome observed in the poor levator function group A. Blepharoptosis under-correction was the most common cause of asymmetric double fold and its occurrence was statistically different between the three groups. The other causes were skin redundancy, brow elevation, double fold loosening, and blepharoptosis over-correction. CONCLUSIONS: The height of a double eyelid can be changed postoperatively by changing levator palpebrae muscle function. In cases of poor levator function, the levator palpebrae muscle is positioned slightly lower than the normal double fold. This condition may result in further relapse or recurrence in the poor levator function group. Also, levator function should be considered among the diverse factors that determine the height of the double fold.

Factors Affecting Stereopsis After Pediatric Cataract Surgery

PURPOSE: To evaluate factors influencing stereoacuity outcomes after pediatric cataract surgery. METHODS: We retrospectively reviewed 38 eyes of 22 patients who had undergone irrigation and aspiration of cataracts and primary posterior chamber intraocular lens implantation from February 1992 to July 2006. In all patients, stereoacuity was assessed with the Titmus stereo test. Patients were divided into two groups according to stereoacuity: group 1 (n=9) had a stereoacuity less than 100 sec/arc; group 2 (n=13) had a stereoacuity more than 100 sec/arc. Nine variables associated with stereoacuity were evaluated in each group. RESULTS: Postoperative strabismus was the strongest factor influencing the stereoacuity level. Good postoperative mean visual acuity was related with good stereoacuity. Though mean visual acuity in two children with exodeviation over 30PD was 0.7 and 0.8, their stereoacuity was 400 sec/arc. Showing little difference in the spherical equivalent between the eyes was also related to good stereoacuity. CONCLUSIONS: Postoperative strabismus onset, postoperative mean visual acuity between the two eyes, and differences in the spherical equivalent were important factors influencing stereoacuity in patients after pediatric cataract surgery.

Surgical Results and Complications of Implanted Primary Intraocular Lenses in Pediatric Cataract

PURPOSE: To evaluate surgical results and complications of different intraocular lenses (IOL) implantation in pediatric cataract surgery. METHODS: We retrospectively reviewed 139 eyes of 80 patients who had undergone irrigation and aspiration of cataracts and primary posterior chamber intraocular lens implantation with posterior continuous curvilinear capsulorhexis and optic capture from July 1998 to December 2005. All the eyes were divided into three groups into the intraocular lenses implanated: group 1 (n=40), PMMA lens was implantated; group 2 (n=42), hydrophobic acrylic lens was implantated; group 3 (n=57), hydrophilic acrylic lens was implanated. The surgical results and complications was evaluated. RESULTS: Wound leakage, iris prolapse, shallow anterior chamber during operation were the most common in group 1. Peripheral anterior synechiae, conjuntival cyst, pigment deposition of IOL, exudative membrane, elevated intraocular pressure were also the most common in group 1 (P<0.05). There was no statistically significant defference in the prevalence of intraoperative and postoperative complications between group 2 and 3. Postoperative final visual acuity and astigmatism were not significantly different between the three groups. CONCLUSIONS: Implantation of hydrophilic acrylic IOLs, as well as hydrophobic acrylic IOLs decrease complications and have good surgical results compared to PMMA IOLs in pediatric cataract surgery.

Surgical Techniques and Postoperative Complications in Pediatric Cataract Surgery

PURPOSE: To evaluate postoperative complications of different surgical techniques in pediatric cataract. METHODS: We retrospectively reviewed 105 eyes of 72 patients who had undergone irrigation and aspiration of cataracts with posterior chamber intraocular lens (IOL) implantation from January 1994 to June 2004. All the eyes were divided into three groups according to the surgical techniques used: group 1 (n=39), IOLs in the bag + intact posterior capsule; group 2 (n=24), IOLs in the bag + posterior continuous curvilinear capsulorhexis (PCCC) + anterior vitrectomy; group 3 (n=42), IOLs in the bag + PCCC + optic capture. Postoperative posterior capsular opacity (PCO), secondary intervention for PCO, strabismus, inflammation, glaucoma, vitreoretinal complications were evaluated. RESULTS: Different from those in the past, current surgical methods for pediatric cataract entail either the optic capture of IOL or anterior vitrectomy through PCCC. PCO is the most frequent postoperative complication. Thirty-five eyes (87.1%) in group 1, 2 eyes (8.3%) in group 2, and no eyes in group 3 developed PCO. Five eyes (33.3%) had recurrence of PCO when PCO was treated by Nd:YAG laser posterior capsulotomy. None had PCO recurrence with secondary optic capture of IOL. Postoperative inflammation and IOL decentration were more common in group 2 than in the other groups. There was no statistically significant difference in the prevalence of postoperative glaucoma between the groups. Neither vitreoretinal complication nor infection was found in our series. CONCLUSIONS: Optic capturing of IOL through PCCC permanently maintains the visual axis with the anterior vitreous face preserved.