Dry Eye Assessment of Patients Undergoing Endoscopic Dacryocystorhinostomy for Nasolacrimal Duct Obstruction Combined with Dry Eye Syndrome

Purpose@#To evaluate the prevalence of dry eye symptoms after endoscopic dacryocystorhinostomy (EDCR) for patients with primary acquired nasolacrimal duct obstruction (PANDO) combined with dry eye syndrome. @*Methods@#The patients diagnosed with PANDO combined with dry eye syndrome who underwent EDCR were divided into two groups according to the questionnaire about dry eye symptoms after surgery. The medical records were retrospectively analyzed. Before and after surgery, we compared the tear meniscus height, tear breakup time, and the presence of corneal punctuate epithelial erosion. The level of dry eyes of patients after surgery was assessed by using the Korean guidelines for the diagnosis of dry eye. @*Results@#At 6 months after EDCR, the proportion of patients with dry eye symptoms was 30% in a total of 80 patients. The duration of epiphora and tear breakup time after EDCR were higher in the group without dry eye symptoms and the proportion of eyes with corneal punctuate epithelial erosion after EDCR was higher in the group with dry eye symptoms. About 15% of total patients started treatment with a dry eye of level 2 or higher. @*Conclusions@#About 15% of patients who underwent EDCR for PANDO combined with dry eye syndrome developed significant dry eye syndrome after surgery. The short onset of epiphora was associated with the development of the dry eye symptoms. Therefore, it is necessary to evaluate dry eye syndrome before surgery, and surgeons should be careful about this.

Endoplasmic Reticulum Stress Induces MUC5AC and MUC5B Expression in Human Nasal Airway Epithelial Cells

OBJECTIVES: Endoplasmic reticulum (ER) stress is known to be associated with inflammatory airway diseases, and three major transmembrane receptors: double-stranded RNA-activated protein kinase-like ER kinase, inositol requiring enzyme 1, and activating transcription factor 6 (ATF6) play important roles in ER stress-related proinflammatory signaling. However, the effects of ER stress and these three major signaling pathways on the regulation of the production of airway mucins in human nasal airway epithelial cells have not been elucidated. METHODS: In primary human nasal epithelial cells, the effect of tunicamycin (an ER stress inducer) and 4-phenylbutyric acid (4-PBA, ER stress inhibitor) on the expression of MUC5AC and MUC5B was investigated by reverse transcriptasepolymerase chain reaction, real-time polymerase chain reaction, enzyme immunoassay, and immunoblot analysis. Small interfering RNA (siRNA) transfection was used to identify the mechanisms involved. RESULTS: Tunicamycin increased the expressions of MUC5AC and MUC5B and the mRNA expressions of ER stress-related signaling molecules, including spliced X-box binding protein 1 (XBP-1), transcription factor CCAAT-enhancer-binding protein homologous protein (CHOP), and ATF6. In addition, 4-PBA attenuated the tunicamycin-induced expressions of MUC5AC and MUC5B and the mRNA expressions of ER stress-related signaling molecules. Furthermore, siRNA knockdowns of XBP-1, CHOP, and ATF6 blocked the tunicamycin-induced mRNA expressions and glycoprotein productions of MUC5AC and MUC5B. CONCLUSION.: These results demonstrate that ER stress plays an important role in the regulation of MUC5AC and MUC5B via the activations of XBP-1, CHOP, and ATF6 in human nasal airway epithelial cells.

Ultra-wide Field Fundus Photography Using Eye Steering Technique in Patients with Symptomatic Posterior Vitreous Detachment

PURPOSE: To evaluate the availability of ultra-wide field fundus photography based on eye steering technique to diagnose retinal breaks in patients with symptomatic posterior vitreous detachment (PVD). METHODS: The medical records of patients with symptomatic PVD were reviewed. Retinal breaks were independently identified using four eye steering capture images of ultra-wide field fundus photographs. The sensitivity and specificity of eye steering capture imaging for diagnosing retinal breaks were calculated. RESULTS: A total of 94 eyes of 94 patients were included. Using fundus examination after pupil dilatation, retinal breaks were diagnosed in 42 (45%) eyes. The sensitivity of the eye steering capture imaging was 98% (95% confidence interval [CI]: 88–100%), and the specificity was 98% (95% CI: 90–100%). Of the 58 retinal tears, 28 (97%) involving the superior quadrant, 10 (100%) involving the inferior quadrant, 6 (100%) involving the nasal quadrant, and 13 (100%) involving the temporal quadrant were identified using eye steering capture images. CONCLUSIONS: Ultra-wide field fundus photography based on eye steering technique was useful for diagnosing retinal breaks in patients with symptomatic PVD. However, eye steering photography could not adequately replace the fundus examination after pupil dilatation in all cases.

A Case of Suprachoroidal Hemorrhage after Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment

PURPOSE: To report a case of a 60-year-old female with rhegmatogenous retinal detachment, presenting with suprachoroidal hemorrhage after vitrectomy. CASE SUMMARY: A 60-year-old woman visited our clinic complaining of floaters, flashing, and blurred vision. Best-corrected visual acuity was 0.1 in her left eye, and fundus examination of her left eye revealed macula-involved retinal detachment with a retinal break at the superotemporal quadrant. She underwent cataract surgery, 23-gauge transconjunctival sutureless vitrectomy, and 14% C3F8 gas tamponade under general anesthesia. One hour after anesthesia recovery, she suddenly complained of severe pain in her left eye. The intraocular pressure measured after removal of the pressure patch from her left eye was as high as 58 mmHg. Her ocular pain improved spontaneously within 10 minutes, and the intraocular pressure decreased to 8 mmHg. Fundus examination of her left eye revealed a reddish-brown raised lesion, suggesting suprachoroidal hemorrhage. She was placed in a prone position with a pressure patch over her left eye. Bleeding through the sclerotomy site was observed 1 day after surgery. Subsequently, hemorrhagic choroidal detachment of her left eye continued to decrease without deterioration. Three weeks after surgery, the patient received an intravitreal injection of 100% C3F8 gas into her left eye. At 3 months after surgery, best-corrected visual acuity had improved to 0.8 in her left eye, and the retina was stable. CONCLUSIONS: Suprachoroidal hemorrhage may be suspected in a patient complaining of severe ocular pain after vitrectomy.

Evaluating the Quality and Contents of Paranasal Sinusitis-Related Information on the Web-Sites in Western Physician and Eastern Physician

BACKGROUND AND OBJECTIVES: A large amount of information related to paranasal sinusitis is available on the internet; however, little is known about the quality and content of such information. We assessed paranasal sinusitis-related information on web sites of western and eastern physicians. MATERIALS AND METHODS: Using the search engine of Naver and Daum, a total of 159 web sites (108 by western physicians, 51 by eastern physicians) were identified by the keyword search "paranasal sinusitis" and were classified using the categories of location and field of contents. These web sites were evaluated for several aspects, and an informational value score was assigned to each. RESULTS: Regarding the location, Seoul (38), Gyeonggi (28), Busan (10) accounted for 70% of sites by western physicians, compared with 76% for the eastern physicians [Seoul (27), Gyeonggi (9), Busan (3)]. With respect to content, main content and Q/A were excellent in sites by eastern physicians whereas clinical schedule was excellent in those by western physicians. The mean informational value of the web sites was 5.17 for western physicians and 2.19 for eastern physicians (p<0.05). CONCLUSION: Web sites on paranasal sinusitis concentrated very firmly on metropolitan areas. Web sites by western physicians provided better paranasal sinusitis-related information than those by eastern physicians.

The Clinical Correlation between Anterior Inferior Cerebellar Artery and Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The influence of anterior inferior cerebellar artery (AICA) loop on sudden sensorineural hearing loss (SSHL) remains controversial. The objective of this study was to evaluate the correlation between the anatomical type of AICA loop and SSHL. SUBJECTS AND METHOD: We reviewed the medical records of 69 ears from 60 patients with SSHL between January 2005 and April 2008, retrospectively. AICA loops were classified according to the Chavda classification method by magnetic resonance imaging. According to the extension depth of the loop in the internal auditory canal, it was classified as type I, II and III. The loop was classified as S (small diameter) and L (large diameter) by comparing the thickness of the loop with adjacent facial nerves. RESULTS: The predominant type of AICA loop was type I (68.1%) and type S (78.3%). There was no significant correlation between the pretreatment hearing level, extension depth and diameter. There was also no significant correlation between the rate of hearing recovery by Siegel's criteria and diameter. However, there was significant correlation between the rate of hearing recovery by Siegel's criteria and the types of the extension depth (p< 0.05). The ears with type II and III of AICA loop presented higher rates of hearing recovery by Siegel's criteria than those with type I. CONCLUSION: This study suggests that the type II and III of AICA loop may be considered a good prognostic factor in SSHL.

A Case of Isolated Frontal Fungal Sinusitis: Treated by Endoscopic Sinus Surgery with Frontal Sinus Minitrephination

The incidence and prevalence of human fungal sinusitis are increasing, because of recently increased immunocompromised host and developed diagnostic tool. Aspergillosis is the most common fungal infection of the paranasal sinuses. The maxillary sinus is most commonly affected by Aspergillus, followed by the sphenoid and ethmoid sinuses. However, isolated frontal fungal sinusitis is extremely rare. Recently, we experienced that a cases of Aspergillus sinusitis of isolated frontal sinus successfully was treated by endoscopic sinus surgery combined with frontal sinus minitrephination (the above and below approach). Therefore, we report this case with a review of the literatures.

A Case of Epidermoid Cyst at Nasolabial Area

Dermoid cysts can be found anywhere in the body, particularly in areas where embryonic elements fuse together. Dermoid cysts arising in the head and neck lesion are relatively common, but that of nasolabial area has not been reported. Recently, we experienced a case of epidermoid cyst mimicking nasolabial cyst. The patient was a 49 year-old man with an anterior nasolabial swelling that has been presented for 1 year. After cyst excision, a histologic examination revealed that it was an epidermoid cyst. We report this case with the literature review.

Effect of Macrolide on the MUC4 Gene Expression in Human Airway Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucin gene expression and mucin secretion are highly increased by inflammatory airway diseases such as asthma, chronic bronchitis and rhinosinusitis. Macrolide antibiotics is considered one of the effective drugs inhibiting mucus secretion for chronic bronchitis and rhinosinusitis with nasal polyp. However, the anti-secretory effect of macrolide is not clear. This study was designed to investigate whether macrolide can suppress interleukin-1beta (IL-1beta)-induced MUC4 gene expression and mucin secretion in the cultured human nasal polyp epithelial cells and NCI-H292 epithelial cells. SUBJECTS AND METHOD: Nasal polyps were obtained from 20 patients with chronic rhinosinusitis with nasal polyp during endoscopic sinus surgery. We observed the effect of roxithromycin on the IL-1beta-induced MUC4 gene and mucin secretion by reverse transcriptase-polymerase chain reaction (RT-PCR) with enzyme-linked immunosorbent assay (ELISA) method. RESULTS: Roxithromycin attenuated the IL-1beta-induced MUC4 mRNA expression and mucin secretion with a dose dependent pattern in both of the cultured human nasal polyp epithelial cells and NCI-H292 epithelial cells. CONCLUSION: This result suggests that roxithromycin may be considered as an effective anti-hypersecretory agent for its down-regulation of the MUC4 gene.