Case of Acute Myeloid Leukemia with Mass of Eyelid and Conjunctiva in the Early Stage

PURPOSE: To report a case of an 82-year-old male with acute myeloid leukemia presenting with bilateral isolated conjunctival and eyelid masses. CASE SUMMARY: An 82-year-old male presented with a bilateral conjunctival mass and right eyelid mass occurring 10 days prior. He was diagnosed with prostate cancer 8 years ago and complete recovery was achieved using selective mass chemotherapy. He experienced a stroke 4 years ago and was treated using a carotid artery stent insertion and medication. In the initial laboratory test, hemoglobin was 13.7 g/dL and leukocyte count 5,530/mm3(neutrophil 74.4%, lymphocyte 10%, monocyte 11.8%). Light reflex, movement of extraocular muscle and fundus examination were all normal. Biopsy was performed 1 week after the first visit. Seven days after biopsy, he complained of sudden dyspnea and febrile sense and was admitted to the intensive care unit via the emergency room (ER). The laboratory tests performed in the ER showed hemoglobin was 9.6 g/dL and leukocyte count was 78,020/mm3(neutrophil 0%, lymphocyte 7%, monocyte 5%, promyelocyte 1%, metamyelocyte 4%, myelocyte 6%, blast 67%). The biopsy revealed diffuse proliferation of atypical plasmacytoid cells, consistent with leukemic infiltration. Under the diagnosis of acute myeloid leukemia, chemotherapy was administered. However, the patient died due to aggravated pneumonia. CONCLUSIONS: Even if non-specific findings appear on the peripheral blood tests, eyelid and conjunctival masses should be considered as possible tumors in acute myeloid leukemia.

Anatomical Location and Distribution of Supraorbital Notch and Foramen Evaluations Using Facial 3D Computed Tomography

PURPOSE: To evaluate anatomical locations and distributions of supraorbital notch and foramen using facial 3D computed tomography in the Korean adult population. METHODS: The study sample was composed of 87 adult patients with no history of trauma or ocular disease. The horizontal position of the supraorbital foramen or notch was recorded in relation to a vertical line defined by a reproducible hypothetical point, such as the nasion and mid-maxilla and the midpoint of the horizontal supraorbital plane. The distance and angle for each supraorbital foramen and notch were calculated from the defined vertical line. Furthermore, vertical distance from supraorbital plane, which was established using the highest points of both supraorbital rims, was obtained from the supraorbital foramen. RESULTS: The mean age of the 87 patients was 45.44 +/- 8.34 years (range, 30-59 years). There were 66 eyes in the supraorbital notch and 108 eyes in the supraorbital foramen. There were no distributional differences between the 2 sides. The mean horizontal distance of both types was 23.95 +/- 3.93 mm (range, 16.41-38.94 mm). The horizontal distance of male patients was longer than the female patients (25.18 +/- 4.16 mm vs. 22.63 +/- 3.19 mm, p < 0.001, based on independent t-test) and the horizontal distance of supraorbital notch was shorter than the supraorbital foramen (22.59 +/- 3.18 mm vs. 26.18 +/- 4.04 mm, respectively, p < 0.001, based on independent t-test). The mean vertical distance and mean angles of the supraorbital foramen were 3.02 +/- 1.119 mm and 6.81 +/- 2.31 degrees (degrees), respectively. CONCLUSIONS: The present study described the anatomical location of each supraorbital opening type in Korean adults. According to horizontal distance, a surgeon can avoid iatrogenic injury of the supraorbital neurovascular complex, especially during brow surgery. In addition, the anatomy can aid in targeting supraorbital neurovascular complex in cases of nerve block.

Orbital Morphology for Decompression Surgery in Thyroid Eye Disease Using 2-D Orbital CT and 4 Parameters

PURPOSE: To present easily measurable 2D orbit computed tomography (CT) reference data that can be used in a preoperative study for orbital decompression and classification of individual orbital morphologies. METHODS: The study sample was composed of 77 patients with orbital contusion (42 Asian males + 35 Asian females = 154 orbits) who visited the emergency room of the Korea University Guro Hospital from September 2012 to June 2013. Patients with orbital wall fracture, retrobulbar hemorrhage, or eyeball rupture were excluded. Medical records including 2D orbit or facial bone CT were retrospectively reviewed and 4 orbital parameters (orbital length, OL; globe length, GL; GL/OL ratio and 2D cone angle) were measured. RESULTS: The average OL was 42.53 +/- 2.46 mm (35.63-49.09 mm) and average GL was 24.83 +/- 1.09 mm (22.75-28.13 mm). The average GL/OL ratio using these 2 parameters was 0.59 +/- 0.04 (0.50-0.68). The posterior cone angle was on average, 45.96 +/- 5.91degrees (29.35-60.04degrees). CONCLUSIONS: Simple measurement of 4 parameters using 2D orbit CT and classification of Asian individual orbital morphology may help in the choice of the most effective surgical technique for decompression surgery in thyroid eye disease patients.

Optic Canal Location Using Computed Tomography (CT)

PURPOSE: In this study we evaluated the location and shape of the optic canal using computed tomography (CT) for diagnosis and treatment of posterior orbital diseases. METHODS: Fifty patients, who had received a facial bone CT between November 2012 and June 2013 at Korea University Hospital were included in the present study. The location and shape of the optic canal was evaluated using 9 parameters on CT (P1: nasal bone tip; P2: middle point of tuberculum sellae; P3: root of columella nasi; P4: orbit end of the optic canal; P5: cranium end or the optic canal; P6: P1's projection on L2; L1: line that links P1 and P2; L2: goes through P3 and parallel to L1; L3: bisector of right and left and goes through P1). RESULTS: The distance between P3 and P4 was 81.5 mm and 75.6 mm in males and females, respectively (p = 0.001). The distance between P3 and P5 was 88.5 mm and 82.1 mm in, males and females, respectively (p = 0.001). The width of the orbital end and cranium end of the optic canal, the length of the optic canal was 2.4 mm, 4.1 mm, 10.9 mm in males and 2.3 mm, 3.6 mm, 10.2 mm, in females, respectively. CONCLUSIONS: By determining the location and shape of the optic canal, these results can facilitate endoscopic approaches to diagnose and manage posterior orbital diseases as well as manage and prevent disorders associated with the optic canal.

Punctoplasty Using a Radiofrequency Surgical Unit for Punctal Stenosis

PURPOSE: To introduce and assess the results of punctoplasty using a radiofrequency surgical unit for punctal stenosis. METHODS: Patients who complained of epiphora, had an intact lacrimal pathway below puncti, and underwent punctoplasty with the Ellman Surgitron F.F.P.F were evaluated in the present study. RESULTS: A total of 19 patients (31 eyes) were included in the study. The average age was 55 years (+/-15.7 years). At the last follow-up visit, 27 eyes (87%) had patent puncti, 1 eye became stenotic again, and 3 eyes were completely obstructed. Twenty-two eyes (71%) showed almost complete disappearance of dye on the fluorescein dye-disappearance test (FDDT). Twenty-five eyes (81%) had symptomatic improvement. No significant complication was reported postoperatively. CONCLUSIONS: Punctoplasty with a radiofrequency surgical unit is a simple and effective method for punctal stenosis.

Comparison of the Central Retinal Vessel Diameter Between Glaucomatous and Normal Eye

PURPOSE:To compare the diameter of central retinal vessels between patients with normal-tension glaucoma, primary open-angle glaucoma and healthy (control) eyes. METHODS: The authors reviewed 30 eyes of 30 normal-tension glaucoma patients, 20 eyes of 20 primary open-angle glaucoma patients and 30 eyes of normal persons who had no systemic vascular diseases. The diameters of the central retinal arteries and veins were measured and calculated using a revised Parr-Hubbard formula, and results were compared between the groups. RESULTS: The diameter of the central retinal vessel showed no statistical differences between the eyes with normal-tension glaucoma and primary-open angle glaucoma. However, there were significant differences between the eyes of patients with glaucoma and the normal control eyes (p<0.05). Conclusion: The diameter of the central retinal vessels in glaucoma patients were narrower than that in the control group. Our results suggest that the diameter of the central retinal vessels may affect the development of glaucoma both in normal tension and primary open-angle types, or that glaucomatous damage may influence the diameter of the central retinal vessels.

Visual Outcome in Children With Congenital Glaucoma

PURPOSE:To evaluate the prognosis of vision and the development of amblyopia in primary congenital glaucoma patients. METHODS: The author reviewed 38 eyes of 22 primary congenital glaucoma patients and evaluated variables such as age at time of surgery and at the last visit, preoperative IOP, Cup-to-disc(CD) ratio, corneal diameter, refractive error, axial lengths and IOP, CD ratio and visual acuity at the last visit. According to visual acuity, the patients were divided into 3 groups, good (>0.5), fair (0.1~0.5), and poor (<0.1). The amblyopia was defined when BCVA was below 0.8 and no evidence of progression of glaucoma. There were 4 types of amblyopia: deprivation, anisometropic, strabismic and organic. The author compared the 3 groups and evaluated factors affecting the vision as well as the prevalence of amblyopia. RESULTS: There were 17 eyes in the good group, 4 eyes in the fair group and 17 eyes in the poor group (p<0.05). Amblyopia developed in 17 eyes with 7 eyes showing deprivation amblyopia. Anisometropic and organic amblyopia were each found in 4 eyes, and strabismic amblyopia was found in 2 eyes. The postoperative IOP and CD ratio and preoperative CD ratio were significantly lower in the good group than the other groups (p<0.05). CONCLUSIONS: Final VA was poor in 45% of eyes with primary congenital glaucoma, and amblyopia developed in 45% of these eyes. The prognosis for vision may be related to the treatment of glaucoma and amblyopia.

Intravitreal Triamcinolone Injection with or Without Bevacizumab for Diabetic Macular Edema

PURPOSE: To compare the effect of intravitreal triamcinolone injection with and without bevacizumab for diabetic macular edema. METHODS: Of 69 patients (69 eyes) diagnosed with diabetic macular edema without any history of other intraocular disease or intraocular operation, 45 eyes (45 patients) were injected with intravitreal triamcinolone (4 mg) and the remaining eyes (24 patients) were injected with triamcinolone (2 mg) and bevacizumab (1.25 mg). The visual acuity and central macular thickness of treated eyes from both groups was measured using OCT, and these measurements were compared between the two groups. RESULTS: There were no statistical differences between the two groups with respect to baseline data. Central macular thickness (CMT) was reduced in both groups, and BCVA improved in both groups. No significant differences were detected in changes in CMT or BCVA between the two groups. CONCLUSIONS: Intravitreal injection of triamcinolone had a beneficial effect on DME in terms of CMT reduction and BCVA improvement. Addition of three consecutive intravitreal bevacizumab injections, however, did not show any significant addictive effect during the follow-up period.

The Effect of Flat Anterior Chamber on the Success of Ahmed Valve Implantation

PURPOSE: To evaluate the outcome following Ahmed valve implantation in patients who developed flat anterior chamber. METHODS: The authors reviewed 60 eyes of 60 patients who underwent Ahmed valve implantation and divided these patients into the flat anterior chamber group (18 eyes) and the control group (42 eyes). The influence of clinical variables on the development of flat anterior chamber and the effect of flat anterior chamber on the success of Ahmed valve implantation were evaluated. RESULTS: The preoperative intraocular pressure, age, and the incidence of neovascular glaucoma as a preoperative diagnosis were higher in the flat anterior chamber group than in the control group (p0.05). CONCLUSIONS: The development of a flat anterior chamber after Ahmed valve implantation appeared not to affect the outcome of the surgery.