Clinical Outcomes of Lower Eyelid Epiblepharon Repair Combined with Minimal Incision of Medial Epicanthoplasty

Purpose@#To introduce a method of correcting lower eyelid epiblepharon with severe epicanthal fold combined with minimal incision of medial epicanthoplasty (Hiraga method) and to report its clinical outcomes. @*Methods@#We retrospectively reviewed the medical records of patients who underwent surgery for lower eyelid epiblepharon and minimal incision of medial epicanthus from January 2015 and January 2019. Seventy-eight eyes of 39 patients were analyzed for surgical outcomes, subjective symptoms, recurrence, and complications for more than six months of the follow-up period. @*Results@#A total of 39 patients (14 male, 25 female) were included in the analysis. The mean patient age was 8.4 ± 4.3 years, and the mean postoperative follow-up was 14 ± 5.2 months. Eyelid shape and function were well maintained in 39 patients (100%), with no recurrence during follow-up. @*Conclusions@#For patients with lower eyelid epiblepharon with severe medial epicanthal fold, lower eyelid epiblepharon with a minimal incision of medial epicanthoplasty (Hiraga method) is a simple surgical technique to prevent recurrence of medial cilia touch, showing successful results without complications.

A Case of Eccrine Spiradenoma of the Eyelid

PURPOSE: To report a case of eccrine spiradenoma that presented as an eyelid nodule. CASE SUMMARY: A 61-year-old female presented with a mass in the right upper lid margin; the onset time was unknown. An ophthalmic examination revealed no abnormalities except the eyelid nodule. The nodule was 3 mm in size with a firm, smooth surface and light pinkish color, and was located near the lid margin. Excision and biopsy of the nodule was performed. The pathological findings of the specimen obtained showed islands of 2 types of lobular cells. Larger, paler cells were grouped around the central area, darker and smaller cells on the periphery. These findings were compatible with eccrine spiradenoma. CONCLUSIONS: Eccrine spiradenoma should be considered a differential diagnosis of a solitary eyelid tumor.

Lacrimal Gland Ductulitis: Clinical Features and Management

PURPOSE: To describe the clinical characteristics and management of a group of patients who had infection of the lacrimal gland ductules. METHODS: We performed a retrospective chart review of 12 patients who had infection of the lacrimal gland ductules and were managed at Saevit Eye Hospital from June 2010 to May 2012. RESULTS: The patients' mean age was 31.8 +/- 17.7 years, and 7 were male and 5 were female. Common symptoms were a painful, swelling mass with mucous discharge (8 eyes) and conjunctival injection (4 eyes) at the lateral canthal area. All patients underwent surgical intervention by incision and curettage. Eleven patients (91.7%) had typical sulfur granule of actinomyces, and 8 patients (66.7%) had many cilia in the expressed debris from the ductule. All patients had resolution of symptoms after the procedure and showed no recurrence. CONCLUSIONS: Infective lacrimal gland ductulitis should be considered when a painful swelling mass with mucous discharge at the lateral canthal area is present. Surgical intervention by incision and curettage can be attempted preferentially as a minimally-invasive treatment option.

Canaliculitis Associated With SmartPlugtrade mark Punctal Plug Insertion: Clinical Features and Management

PURPOSE: To report the clinical features and treatment of canaliculitis associated with SmartPlug punctal plug insertion. METHODS: Case selection criteria included patients with canaliculitis, who were managed at Seoul National University Hospital from January 2006 to October 2008, presenting with a history of punctal plug insertion. The operation reports were reviewed to identify patients in whom SmartPlug was discovered during the operation. Six patients (8 eyes) were identified, and a retrospective chart review was performed for all the patients. RESULTS: The mean age of the patients was 34.3+/-8.6 years, and there were 1 men and 5 women. Common symptoms were mucous discharge (6 eyes) and conjunctival injection (2 eyes). The mean time from insertion of the plug to onset of symptoms was 27.0+/-27.0 months (range 4 to 77 months). All patients underwent surgical removal of the punctal plug by one-snip punctoplasty, canalicular retrograde compression using 2 cotton-tipped applications (2 eyes), or canalicular curettage (6 eyes). All patients had resolution of symptoms after the procedure. CONCLUSIONS: Canaliculitis should be considered when there is conjunctival discharge or injection in patients with SmartPlug. One-snip punctoplasty and retrograde compression of canaliculus can be attempted preferentially as a minimally-invasive treatment option.

A Case of Eyelid Schwannoma

PURPOSE: To report a rare case of solitary eyelid schwannoma. CASE SUMMARY: A 60-year-old female visited our clinic with a small cyst-like mass of the left upper eyelid, which had developed 3 years earlier. A 3x3 mm-sized, nonpigmented, cyst-like mass was located in the lateral area of the left upper eyelid margin. We performed an excisional biopsy under local anesthesia. The tumor was well encapsulated, easily dissected, and could be completely removed. Histopathologic examination showed cellular areas of spindle cells with Verocay bodies forming palisades and less cellular myxoid areas. Immunohistochemical analysis for S-100 protein showed a strongly positive reaction. Based on the histopathologic features, a diagnosis of benign Schwannoma was made. CONCLUSIONS: Schwannoma should be also considered in the differential diagnosis of a well-circumscribed mass lesion in the eyelid.

Cost-Effectiveness of Early Surgical or Medical Therapy for Primary Open-Angle Glaucoma: A Decision Analytic Model

PURPOSE: To estimate the cost-effectiveness of treatment with early surgical therapy for primary open-angle glaucoma compared with early medical therapy. METHODS: The hypothetical patient was treated with early surgical or early medical therapy. Relevant costs were obtained from 2002 National Health Insurance data. The success rate of each therapy was obtained from previous reports. Cost-effective Markov model was created using the medical decision analysis program. Markov approach simulated disease progression. Matrix calculation and Monte Carlo simulation were used to determine whether there was a significant difference in quality-of-life adjusted years (QALYs) gained between surgical and medical therapy. RESULTS: In Moorfields study cost-effectiveness for early surgical therapy and medical monotherapy were 110, 161 W/QALYs and 189, 616 W/QALYs, respectively. In the Collaborative Initial Glaucoma Treatment Study (CIGTS) cost-effectiveness for early surgical therapy and medical monotherapy were 153, 578 W/QALYs and 201, 353 W/QALYs, respectively. Matrix calculation and Monte Carlo simulation showed that early surgical therapy was superior cost-effective treatment to medical therapy. CONCLUSIONS: By cost-effective Markov medical decision model, early surgical therapy for primary open-angle glaucoma is a cost-effective treatment option and is superior to medical therapy.

Sensory Status in Patients Showing Orthophoria After Strabismus Surgery in Exotropes

PURPOSE: The purpose of this study is to evaluate sensory function and stereoacuity in patients showing orthophoria after surgery in exotropes, and to elucidate factors influencing postoperative improved sensory status METHODS: We prospectively studied 45 patients showing orthophoria or exophoria within 4 prism diopters after strabismic surgery in exotropes. Three tests (Worth-4-dot test, Bagolini striated lens test and Titmus test) were performed at pre and postoperative period. We studied the effect of different variables (age at surgery, visual acuity, angle of deviation, Bagolini striated lens test, Titmus test, anisometropia, and fusional status) with suspected clinical influence on the sensory and motor outcomes. RESULTS: In Worth-4-dot test, 34 patients (75.6%) showed improvement after surgery. Thirty-three patients (73.3%) and 35 patients (77.8%) showed improvement respectively in the Bagolini striated lens test and Titmus test. Thirty-eight patients showed improvement in 2 or more tests after surgery and 7 patients showed no change. Of patients showing preoperative abnormal response in each test, 21 patients (65.6%) in Worth-4-dot test, 14 patients (53.8%) in Bagolini striated lens test, and 22 patients (68.8%) in Titmus test showed normal response at postoperative 6 months. Of 3 tests and other factors, Bagolini striated lens test was the only factor predicting postoperative sensory recovery (x2=4.18, P<0.05). CONCLUSIONS: In patients showing orthophoria or exophoria within 4 prism diopters after strabismic surgery in exotropes, Bagolini striated lens test was the only meaningful factor predicting postoperative sensory recovery