Associations of Type of Orbital Trauma with Orbital Wall Fracture Pattern of Retinal Contusion

Purpose@#To investigate the associations of type of orbital trauma with pattern of retinal contusion and the characteristics of orbital wall fracture in patients, and to assist in the treatment of orbital trauma. @*Methods@#We retrospectively reviewed the medical records of 351 eyes in 351 patients with orbital wall fractures or retinal contusion among patients with orbital trauma who came to the hospital via the emergency room between March 2018 and August 2019. Patients were divided into two groups according to the presence or absence of retinal contusion. Age, sex, and cause of trauma were investigated in each group. In addition, the characteristics of the patients were analyzed according to the range of peripheral retinal contusion, and whether the retinal contusion invaded the fovea. In addition, the relationship between the location of orbital fractures and area of retinal contusion was analyzed. @*Results@#“Assault” was the most common cause of orbital trauma in the retinal contusion group (19 of 41 eyes, 46.3%). “Traffic accident” was the most common cause of orbital trauma in the group with only orbital fracture without retinal contusion (108 of 310 eyes, 34.8%). The proportion of multiple orbital fractures was significantly higher in the group with a wide rather than a narrow range of peripheral retinal contusions (p = 0.020). “Flying object” was listed as the cause of orbital trauma significantly more often in the foveal contusion group than the intact fovea group (p = 0.036). @*Conclusions@#Retinal contusions were found significantly more often in cases with orbital trauma due to “assault” or “flying object”. In the presence of multiple orbital wall fractures, the range of peripheral retinal contusion was wide. Retinal contusion due to “flying object” showed the highest rate of foveal involvement.

Associations of Type of Orbital Trauma with Orbital Wall Fracture Pattern of Retinal Contusion

Purpose@#To investigate the associations of type of orbital trauma with pattern of retinal contusion and the characteristics of orbital wall fracture in patients, and to assist in the treatment of orbital trauma. @*Methods@#We retrospectively reviewed the medical records of 351 eyes in 351 patients with orbital wall fractures or retinal contusion among patients with orbital trauma who came to the hospital via the emergency room between March 2018 and August 2019. Patients were divided into two groups according to the presence or absence of retinal contusion. Age, sex, and cause of trauma were investigated in each group. In addition, the characteristics of the patients were analyzed according to the range of peripheral retinal contusion, and whether the retinal contusion invaded the fovea. In addition, the relationship between the location of orbital fractures and area of retinal contusion was analyzed. @*Results@#“Assault” was the most common cause of orbital trauma in the retinal contusion group (19 of 41 eyes, 46.3%). “Traffic accident” was the most common cause of orbital trauma in the group with only orbital fracture without retinal contusion (108 of 310 eyes, 34.8%). The proportion of multiple orbital fractures was significantly higher in the group with a wide rather than a narrow range of peripheral retinal contusions (p = 0.020). “Flying object” was listed as the cause of orbital trauma significantly more often in the foveal contusion group than the intact fovea group (p = 0.036). @*Conclusions@#Retinal contusions were found significantly more often in cases with orbital trauma due to “assault” or “flying object”. In the presence of multiple orbital wall fractures, the range of peripheral retinal contusion was wide. Retinal contusion due to “flying object” showed the highest rate of foveal involvement.

High-grade Mucoepidermoid Carcinoma of the Lacrimal Gland

No abstract available.

Regulation of Matrix Metalloproteinase 2 Expression by an Adenosine A1 Agonist in Trabecular Meshwork Cells

PURPOSE: We investigated the extent of adenosine A1 agonist-induced expression and regulation of matrix metalloproteinase 2 (MMP-2) synthesis in human trabecular meshwork cells (HTMC). METHODS: Primary HTMC cultures were exposed to 0.1 or 1.0 µM N6-cyclohexyladenosine (CHA) for 2 h in the presence or absence of an inhibitor thereof, 8-cyclopentyl-1,3-dimethylxanthine (CPT). The expression level of mRNA encoding MMP-2 was assessed via reverse transcription-polymerase chain reaction, and the levels of tissue inhibitor of metalloproteinase 2 (TIMP2) and membrane-type-1 MMP (MT1-MMP) measured by Western blotting. The permeability of the HTMC monolayer was assessed with the aid of carboxyfluorescein. RESULTS: CHA at 1.0 µM increased the permeability of the HTMC monolayer (p = 0.003) and CHA at both 0.1 and 1.0 µM significantly increased MMP-2 mRNA expression, which was inhibited by co-exposure to CPT (all p < 0.05). CHA increased MMP-2 activity, decreased that of TIMP2, and increased that of MT1-MMP (all p < 0.05). CONCLUSIONS: CHA increased the permeability of the HTMC monolayer and increased MMP-2 activity, decreased TIMP2 activity, and increased MT1-MMP activity. Thus, regulation of TIMP2 and MT1-MMP expression may be involved in the adenosine A1 agonist-induced increase in MMP-2 activity.

Effect of Rho Kinase Inhibitor on the Production of Nitric Oxide in Trabecular Meshwork Cells

PURPOSE: To investigate the effects of Rho kinase (ROCK) inhibitor on the production of nitric oxide (NO) and expression of endothelial nitric oxide synthase (eNOS) in cultured human trabecular meshwork cells (HTMC). METHODS: Primarily cultured HTMC were exposed to 0 µM, 10 µM or 100 µM Y-27632 for 3 days and NO production was assessed using Griess assay. After 24 hours, the effect of Y-27632 on the contraction of collagen matrix and the permeability of the HTMC monolayer was determined. The expression of eNOS mRNA was assessed using reverse transcription-polymerase chain reaction (RT-PCR) and cellular survival with the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay. RESULTS: In HTMC, 10 µM and 100 µM Y-27632 significantly increased NO production after 1 day and 3 days (p = 0.020 and 0.001, respectively). At 1 day after exposure, Y-276320 significantly relaxed the collagen matrix and increased the permeability of the HTMC monolayer (all p = 0.001) and the eNOS mRNA expression (p = 0.039). CONCLUSIONS: Increased NO production may play a role in the mechanism of increased trabecular outflow associated with ROCK inhibitor.

Successful Treatment of Rhino-Orbital Mucormycosis with Posaconazole after Combination of Surgical Treatment and Amphotericin B

PURPOSE: To report a case of rhino-orbital mucormycosis successfully treated by posaconazole salvage therapy after a surgical intervention combined with amphotericin B treatment. CASE SUMMARY: A 57-year-old female with uncontrolled diabetes mellitus presented to our department with left periorbital swelling and pain for 3 days. At initial presentation, complete ptosis, complete external ophthalmoplegia, and exophthalmos of 6 mm were observed in the left eye. Pupillary reflex was absent in the left eye. Orbital magnetic resonance imaging showed left focal maxillary sinusitis and left posterior orbital inflammatory infiltration with left optic nerve involvement. Nasal endoscopic examination showed black eschar in both nasal cavities. Histopathological examination of the involved nasal cavities showed non-septated fungal hyphae with blunt-angle branching, thus rhino-orbital mucormycosis was diagnosed. The patient underwent a lid-sparing subtotal exenteration, wide endonasal debridement of the nasal necrotic tissues, and intravenous injections of amphotericin B for 7 weeks. The patient continued to receive oral posaconazole salvage therapy for 6 months and was successfully treated. At the 44-month follow-up, recurrence was not observed, and the patient is wearing a new type of silicone oculofacial prosthesis. CONCLUSIONS: Rhino-orbital mucormycosis is an aggressive, opportunistic fungal infection that is life-threatening despite exenteration and amphotericin B treatment. Sequential use of oral posaconazole as salvage therapy may be helpful for a successful treatment.

Effect of Amniotic Membrane Extract on Cultured Human Nasal Mucosa Fibroblasts

PURPOSE: To investigate the effects of amniotic membrane extract (AME) on the survival of cultured human nasal mucosa fibroblasts. METHODS: Primary cultured human nasal mucosa fibroblasts were exposed to 0, 10, 20, or 30 microg/mL AME for 3 days. The survival of the human nasal mucosa fibroblasts was measured using the MTT assay and apoptosis was evaluated with flow cytometry using annexin-V/propidium iodide double staining. RESULTS: AME decreased significantly in fibroblast proliferation after exposure to 10 microg/mL (p = 0.000), and caused significant apoptosis of the fibroblasts after exposure to 10 microg/mL (p = 0.024). CONCLUSIONS: AME decreased fibroblast proliferation in vitro at least through induction of apoptosis. Therefore, adjuvant use of AME during endonasal dacryocystorhinostomy may improve clinical outcomes.

Flow Cytometric Analysis of the Effects of Resveratrol on the Survival of Human Tennon's Capsule Fibroblasts

PURPOSE: Resveratrol exerts cytoprotective or cytotoxic effects according to cell type. This study was performed to evaluate the effects of resveratrol on the survival of cultured human Tenon's capsule fibroblasts (HTFBs). METHODS: Primarily cultured HTFBs were exposed to 0, 10, or 100 microM resveratrol for 3 days. Cellular survival was assessed using the MTT assay and degree of apoptosis was analyzed with flow cytometry using annexin-V/propidium iodide double staining. RESULTS: Resveratrol decreased the survival of HTFBs after exposure to 10 microM (p = 0.04). In flow cytometric analysis, 10 microM resveratrol did not affect the degree of apoptosis (p = 0.89), but 100 microM resveratrol increased the degree of apoptosis (p = 0.003). Both 10 and 100 microM resveratrol did not affect the degree of necrosis (p = 0.74, 0.33). CONCLUSIONS: Resveratrol decreased cellular survival of cultured HTFBs and induced apoptosis. Thus, resveratrol may exert antiproliferative effects on HTFBs.

Long-Term Outcomes after Cryotherapy for Conjunctival Mucosa-Associated Lymphoid Tissue Lymphomas

PURPOSE: To evaluate long-term outcomes after cryotherapy for conjunctival mucosa-associated lymphoid tissue (MALT) lymphomas. METHODS: We retrospectively analyzed 11 eyes of 8 patients who underwent cryotherapy with a confirmed histopathological diagnosis of conjunctival MALT lymphoma between January 2006 and December 2010 and were followed up for at least a year. RESULTS: The mean patient age was 36.8 years and the average follow-up was 4.1 years. Complete remission was achieved in 3 patients (4 eyes) and recurrence occurred in 5 patients (7 eyes) after the first cryotherapy. After the third cryotherapy, complete remission was achieved in 2 patients (2 eyes) and recurrence occurred in 3 patients (5 eyes). Therefore, 3 patients (5 eyes) underwent radiotherapy and finally achieved complete remission. After cryotherapy, significant complications were not observed except mild symblepharon in 4 patients (6 eyes). CONCLUSIONS: Cryotherapy, although having a higher recurrence rate than radiotherapy, is a simple treatment modality with fewer complications for patients. In the conjunctival MALT lymphoma patients who cannot undergo radiotherapy, cryotherapy should be considered as an alternative treatment modality.

A Case of Erdheim-Chester Disease with Diplopia

PURPOSE: We present a case of Erdheim-Chester disease (ECD) with diplopia. CASE SUMMARY: A 56-year-old woman came to the hospital with a 6-week history of diplopia on left lateral gaze. The right eye showed mildly limited adduction. Humphrey automated perimetry demonstrated inferior bitemporal quadrantanopia. Orbital and brain magnetic resonance imaging revealed well-defined orbital masses in both intraconal orbits with homogenous enhancement, as well as multiple masses of homogenous signal intensity in the brain. Systemic evaluation showed involvement of the long bones, and retroperitoneum, but no involvement of the heart, or lungs. Incisional biopsy of the right orbital mass was performed. Histopathological examination showed numerous lipid-laden histiocytes and few multinucleated Touton giant cells. Immunohistochemical staining showed positivity for CD68, but negativity for CD1a, and ECD was therefore diagnosed. The patient received treatment with radiation therapy and interferon-alpha, but died due to sepsis secondary to urinary tract infection after 2 months. CONCLUSIONS: Except exophthalmos, diplopia may be the only initial symptom of an orbital mass. Although rare, the possibility of ECD should be considered in the differential diagnosis of both retrobulbar and orbital masses with diplopia.

A Case of Bilateral Trochlear Nerve Palsy Following Cisternography

PURPOSE: To report a case of bilateral trochlear nerve palsy following cisternography. CASE SUMMARY: A 43-year-old male with intermittent watery rhinorrhea persisting for 3 months visited the neurosurgery department of our institute. His past medical history included removal of a pituitary adenoma 22 years prior to presentation. Cerebrospinal fluid leakage was suspected and cisternography was performed. The patient was referred to our ophthalmology department for diplopia 3 days after the cisternography. An alternate prism cover test showed 5 prism diopter (PD) right hypertrophia in the primary position, and underaction of bilateral superior oblique muscles and overaction of the left inferior oblique muscle. A positive Bielschowsky test with the head tilted to either side was observed and excyclotorsion was 9degrees on the double Maddox rod test. The patient was diagnosed with bilateral trochlear nerve palsy. After 2 years of follow-up, diplopia persisted and recession of the bilateral inferior oblique muscles was performed. After the surgery, diplopia disappeared, the fundus photography showed no excyclotorsion, and the double Maddox rod test indicated 3degrees of excyclotorsion. CONCLUSIONS: Cisternography should be carefully performed due to the possibility of bilateral trochlear nerve palsy, an extremely rare but possible occurrence following the procedure.

Effect of Mitomycin C and 5-Fluorouracil on Cultured Human Nasal Mucosa Fibroblasts

PURPOSE: To investigate the effects of two antimetabolites, mitomycin C (MMC) and 5-fluorouracil (5-FU), on proliferation of cultured human nasal mucosa fibroblasts. METHODS: Human nasal mucosa fibroblasts were primarily cultured, and exposed to various concentrations of MMC and 5-FU for 5 minutes. Control fibroblasts were exposed to only DMEM media without the drugs. Effect of drugs on cell morphology was observed by phase-contrast microscopy. Cell viability and apoptosis were measured using MTT [3-(4,5-dimethylthiazol- 2-yl)-2,5-diphenyl-tetrazolium bromide] assay and Acridine orange/Hoechst (AO/HO) staining, respectively. RESULTS: In both experimental groups exposed to MMC and 5-FU, fibroblasts maintained standard spindle shape. The MTT assay showed that both MMC and 5-FU inhibited fibroblast proliferation in a dose dependent manner. AO/HO staining showed apoptotic cells in both experimental groups. CONCLUSIONS: Both MMC and 5-FU have an antiproliferative effect on fibroblasts in vitro at least through induction of apoptosis. Therefore, adjuvant use of either MMC or 5-FU during endonasal dacryocystorhinostomy may improve the clinical outcome by inhibiting proliferation of the nasal mucosa.

A Case of Conjunctival Dermoid Cyst of the Orbit

PURPOSE: To report a case of primary conjunctival dermoid of the superonasal orbit. CASE SUMMARY: A 41-year-old man complained of swelling of the left lower eyelid and left periocular pain for a week. Examination revealed 3 mm of proptosis with superotemporal displacement of the left eye. Orbital CT revealed a 32x27x33-mm well-defined giant cyst with a fat-fluid level in the superonasal aspect of the left orbit. Orbital MRI showed bone remodeling around the cyst, consistent with a dermoid cyst. The cyst was approached via lateral orbitotomy and transcaruncular incision but was ruptured just prior to the end of the dissection and was totally excised using a cryoprobe to freeze the ruptured site. Upon histopathological examination, the cyst was misdiagnosed as a conjunctival cyst because there was no dermal appendage but was rediagnosed as a conjunctival dermoid cyst after the tissue sample was examined more thoroughly. After surgery, the patient presented with diplopia due to esodeviation and was prescribed prismatic lenses.

A Case of Endogenous Klebsiella Endophthalmitis Associated with Acute Pyelonephritis in a Patient with Chronic Renal Failure / 대한신장학회지

Endogenous endophthalmitis is any inflammation of the internal ocular space that usually has a poor prognosis for visual recovery, and is a rare complication of Klebsiella pneumoniae septicemia. We report here a case of endogenous endophthalmitis due to K. pneumoniae in a patient with acute pyelonephritis and chronic renal failure who did not have any history of diabetes mellitus. A 75-year-old woman was admitted to our hospital, complaining of severe pain and decreased vision in the right eye, accompanied by fever and nausea, of 48 hours' duration. Ophthalmologic evaluation and intervention were performed. Blood, urine and vitreous cultures were all positive for K. pneumoniae. She was treated with intravenous antibiotics, intravitreal antibiotics injection and pars plana vitrectomy. However, her right eye showed progressive worsening to enucleation, and she has been on maintenance hemodialysis ever since.

Oculocardiac Reflex during Ptosis Operation under Local Anesthesia

PURPOSE: To evaluate the incidence and examine the development of oculocardiac reflex during ptosis operation under local anesthesia. METHODS: Twenty-eight patients (52 eyes) who underwent ptosis operation under local anesthesia participated in this prospective study. We examined the change of heart rate. We also investigated the incidence of oculocardiac reflex and analyzed factors associated with it. RESULTS: The mean preoperative heart rate was 76.06+/-11.24 beats/min. During local anesthetic injection, skin incision, traction of the central fat pad, traction of the medial fat pad, traction of the levator palpebrae muscle, the mean heart rates were 74.81+/-12.64 beats/min, 74.73+/-12.20 beats/min, 73.63+/-11.73 beats/min, 73.35+/-12.24 beats/min, 71.44+/-11.93 beats/min respectively. Hence, the mean heart rate decreased during each successive part of the operation. The oculocardiac reflex was positive in 24 (46.2%) of 52 eyes. There was no significant difference between the incidence of oculocardiac reflex in males and females. The incidence of oculocardiac reflex was highest during traction of the levator palpebrae muscle. CONCLUSIONS: During ptosis operation under local anesthesia, oculocardiac reflex can occur. Gentle manipulation of surgical tissues and cardiac monitoring is needed to prevent side effects from oculocardiac reflex.

Two Cases of Conjunctival Mucosa-associated Lymphoid Tissue (MALT) Lymphomas Treated by Cryotherapy

PURPOSE: To report two cases of conjunctival mucosa-associated lymphoid tissue (MALT) lymphomas treated with cryotherapy. CASE SUMMARY: Two patients with MALT lymphoma of the conjunctiva were treated by carbon dioxide cryotherapy under topical anesthesia using 0.5% proparacaine hydrochloride (Alcaine(R), Alcon). Cryotherapy was repeated in recurrent lesions up to three times. One patient was free of the tumor for 18 months of follow-up after the third cryotherapy was performed. The second patient had complete disease arrest for 9 months after the third cryotherapy. Neither patient experienced complications during the follow-up period. CONCLUSIONS: Cryotherapy is a comparatively easy treatment tool with fewer complications for patients, making it preferable from a patient's perspective as well. Cryotherapy may be a useful treatment modality in patients with MALT lymphomas localized to the conjunctiva.

Anterior Displacement of Muscle Insertion Site during Strabismus Surgery

PURPOSE: To study how far the insertion site of the extraocular muscle is displaced during strabismus surgery. METHODS: We studied 69 eyes of 36 patients for concomitant exodeviation. The distance between the center of the extraocular muscle insertion site and the nearest posterior limbus was measured before and after detaching the lateral rectus muscle. After fixating the insertion stump with forceps, the distance between the same points was measured. RESULTS: The distance between the limbus and the insertion site was measured as 6.54+/-0.65 mm before detaching the lateral rectus, 6.39+/-0.65 mm after detaching the muscle from the insertion, and 6.30+/-0.64 mm fixation of the insertion stump with forceps. Therefore, the muscle insertion site became displaced by 0.15+/-0.18 mm anteriorly from its original site after disinserting the muscle, and displaced anteriorly by a total of 0.25+/-0.22 mm after fixating the insertion stump with forceps. Differences in the distance at each stage were statistically significant (p<0.01, paired t-test). CONCLUSIONS: The insertion site of the lateral rectus muscle may be displaced anteriorly after disinserting the muscle and fixating the insertion stump with forceps. Therefore, the probability of error in strabismus surgery should be considered.

Hydatid Cyst of the Orbit

PURPOSE: Most hydatid cysts affecting humans grow in the liver and the lung, but orbital involvement is very rare. To our knowledge, this is the first report of a hydatid cyst of the orbit in Korea. METHODS: A 33-year-old woman came to the hospital with a 2-month history of slowly progressive proptosis and ocular pain of the right eye. The right eye showed proptosis, visual impairment and mild limitation of abduction. Orbital CT and MRI revealed a 32X20X24-mm well-defined unilocular cyst in the retrobulbar, intraconal area of the right orbit. RESULTS: The cyst was surgically removed with lateral orbitotomy and it ruptured just prior to the end of the operation. Complete aspiration of the cystic fluid and in situ irrigation with gentamicin-normal saline mixture were performed. Histopathological examination revealed a hydatid cyst. After surgery, the visual acuity and primary position of the right eye were recovered, but its abduction was mildly limited.

Effect of Prostaglandin F2alpha on the Production of Nitric Oxide in Cultured Ciliary Muscle Cells

PURPOSE: To investigate whether prostaglandin F2alpha (PGF2alpha) affects on the production of nitric oxide (NO) in cultured ciliary muscle (CM) cells. METHODS: Following primary culture of CM cells from porcine eyes, the cells were exposed to PGF2alpha (PhXA85, latanoprost free acid) with and without pretreatments of NO synthase inhibitor (L-NAME, N omega- Nitro-L-arginine methyl ester) and cyclooxygenase inhibitors (indomethacin and dexamethasone) for 3 days. The cellular survivals were also evaluated in serum-deprived and hypoxic conditions induced by sodium cyanide. The cellular survival and nitrite production were assessed by MTT and Griess assay, respectively. RESULTS: PGF2alpha enhanced the production of NO significantly in cultured CM cells in a dose-dependent manner, while various inhibitors abolished this effect. PGF2alpha was not cytoprotective in serum-deprived and hypoxic conditions. CONCLUSIONS: The current results suggest that PGF2alpha potentiates NO production but is not cytoprotective in CM cells. This PGF2alpha-induced NO production in CM cells may be involved in the regulation of uveoscleral outflow.

Role of Nitric Oxide on the Proliferation of Human Tenon Capsule Fibroblasts

PURPOSE: To investigate the role of nitric oxide(NO) on the survival and proliferation of human Tenon capsule fibroblasts(HTCF) in tissue culture. METHODS: Following exposure to NO donor such as sodium nitroprusside(SNP) or to NO synthase inhibitor such as N omega-Nitro-L-arginine methyl ester(L-NAME) at various concentrations for 24 hr in the media with or without serum, the cellular proliferation and nitrite production were assessed by rapid colorimetric assay (MTT assay) and Griess assay, respectively. RESULTS: L-NAME decreased the cellular proliferation of HTCF in a dose-dependent manner. In contrast, SNP increased the proliferation in a dose-dependent manner. The differences of nitrite production were more remarkable in the serum-deprived condition with the L-NAME or SNP administration. CONCLUSIONS: NO donor has a proproliferative, and NOS inhibitor has a antiproliferative activities on the proliferation of HTCF. This suggests that NO may be act as an important modulator in wound healing.