Causes and Surgical Outcomes of Lower Eyelid Retraction

PURPOSE: To investigate the causes of lower eyelid retraction and evaluate the outcomes of various surgical procedures. METHODS: We conducted a retrospective medical record review of patients who underwent lower eyelid retraction surgery performed by a single surgeon at Kim's Eye Hospital between 2006 and 2013. We investigated the causes of lower eyelid retraction, clinical history, characteristics, treatment, and surgical outcomes. Preoperative and postoperative margin reflex distance 2 and inferior scleral show were measured for each eyelid. Success was defined as a positive eyelid elevation and a decrease in inferior scleral show. RESULTS: A total of 19 lower eyelids were treated in 14 patients with lower eyelid retraction. For cosmetic reasons, surgical correction for congenital lower eyelid retraction was performed on seven eyelids (36.8%). Ten eyelids (52.6%) exhibited secondary lower eyelid retraction after surgery. One eyelid (5.3%) was affected by facial palsy and one eyelid (5.3%) exhibited exophthalmos of an unknown origin. We adopted a selective approach based on lower eyelid retraction severity. Spacer grafting via a subconjunctival approach was the most commonly performed surgical technique (13 eyelids, 68.4%). The lateral tarsal strip procedure was used to horizontally tighten three eyelids (15.8%). At the time of the procedure, one of these eyelids (5.3%) also received an adjuvant suborbicularis oculi fat lift. Autogenous dermis fat grafting was performed on two lower eyelids (10.5%), whose retraction was caused by fat and soft tissue loss. Cosmetic outcomes were satisfactory in all cases. CONCLUSIONS: To achieve satisfactory surgical outcomes, surgeons should adopt an approach based on the severity of lower eyelid retraction. Mild lower eyelid retraction can be corrected without grafts. When retraction is severe and exceeds 2 mm, spacer grafts that push the lower eyelid margin upwards and support it from below are required.

Predictors of Silicone Tube Intubation Success in Patients with Lacrimal Drainage System Stenosis

PURPOSE: To evaluate prognostic factors affecting silicone tube intubation outcomes in Asian patients with lacrimal drainage system stenosis. METHODS: A retrospective review was conducted on the medical records of 822 patients (1,118 eyes) who had undergone silicone tube intubation to treat lacrimal drainage system stenosis between January 2011 and December 2012. Patients were divided into two groups: a success group and a failure group. Success was defined as the disappearance of epiphora symptoms, normalization of tear meniscus height, and the easy passage of fluid without resistance on the postoperative syringing test. Patient and ocular parameters were compared between the success and failure groups. RESULTS: A total of 994 eyes of 727 patients were included in analyses. Patients had a mean follow-up period of 34.11 ± 18.70 weeks. Silicone tube intubation was successful in 67.2% of participants. Significant differences between the success and failure groups were found for age (p < 0.001), history of ipsilateral facial palsy (p = 0.028), follow-up period (p < 0.001), and degree of passage on the preoperative syringing test (p = 0.001). Only age (p < 0.001) and degree of passage on the preoperative syringing test (p = 0.002) remained significantly associated with silicone tube intubation success in multivariate analysis. CONCLUSIONS: Age was negatively associated with silicone tube intubation success in patients with lacrimal drainage system stenosis. The success rate was higher in patients who showed easy passage of fluid without resistance on the preoperative syringing test. These factors should be considered by surgeons planning silicone tube intubation in patients with lacrimal drainage system stenosis.

Preoperative Computed Tomography Findings for Patients with Nasolacrimal Duct Obstruction or Stenosis

PURPOSE: To identify and analyze the role of preoperative computed tomography (CT) in patients with tearing symptoms with nasolacrimal duct obstruction (NLDO). METHODS: We retrospectively reviewed the medical records and CT results on 218 patients who complained of tearing symptoms with NLDO between January 2014 and December 2014. All patients were recruited from Kim's Eye Hospital's outpatient clinic and assessed by clinical history, examination, and CT to evaluate periocular pathology and nasolacrimal drainage system. Patients with abnormal findings assessed by preoperative CT were further reviewed. RESULTS: CT was performed on 218 patients (average age, 58.2 ± 11.9 years). Of these, 196 (89.9%) had endonasal dacryocystorhinostomy, 14 (6.4%) declined surgery, and 8 (3.7%) were inoperable due to abnormal CT findings. Soft tissue opacity was the most common finding which 243 cases (85.9%) of 283 obstructed nasolacrimal duct and 89 cases (81.7%) of 109 non-obstructed nasolacrimal duct showed it. Thirty-nine (17.8%) of 218 patients showed either maxillary sinusitis or ethmoidal sinusitis and 32 (14.7%) of 218 patients presented with periocular inflammation. Other abnormal CT findings included septal deviations, previous fractures, masses, and structural abnormalities of nasal cavity. CONCLUSIONS: Preoperative CT imaging is useful in the assessment of both nasolacrimal drainage and nearby anatomical structures. This information will be helpful in planning surgical interventions and management of NLDO.

A Case of Fungal Keratitis Scedosporium apiospermum

PURPOSE: To report a case of fungal keratitis caused by Scedosporium apiospermum. CASE SUMMARY: A 70-year-old man visited our clinic with complaints of redness and decreased visual acuity in his right eye caused by a soil gotten into an eye while gardening 10 days ago. The patient had previously been treated in a local clinic but did not show significant clinical improvement. Bacterial and fungal staining, culture, and an antibiotic sensitivity test were performed from a corneal scrape. The cultures revealed growth of Scedosporium apiospermum. The patient was treated with topical moxifloxacin antibiotics, fluconazole, amphotericin B antifungal agents. However, the lesion was not improved, so antifungal therapy was switched to topical voriconazole. After two months of treatment, the infection was resolved with mild scarring. CONCLUSIONS: Although it is a rare pathogen, Scedosporium apiospermum should be considered as a potential pathogen in patients presenting with corneal ulceration due to trauma from an object contaminated by soil, polluted water, or spoiled plant contact. And we suggest that topical application of voriconazole may be a good alternative treatment for patient with fungal keratitis in which no improvement despite a conventional antifungal agent, fluconazole.

Comparison of Bacterial Culture Rate and Bacterial Floral Distribution in Anophthalmic Patients with Prosthetic Eye, Between Patients with Symptom and Without Symptom

PURPOSE: To evaluate the distribution of conjunctival bacterial flora in anophthalmic socket patients with a prosthetic eye, and compare the bacterial positive culture rates between patients with subjective symptoms such as eye wax or irritation and patients without symptoms. METHODS: Twenty-six anophthalmic socket patients with a prosthetic eye who visited our clinic between December 2009 and May 2011 were retrospectively analyzed. The patients were asked about their symptoms, followed by a conjunctiva examination. Specimens were obtained from the inferior conjunctival cul- de- sac with a sterile cotton-tipped applicator. The collected specimens were cultured. RESULTS: The results indicated that the overall positive culture rate in the anophthalmic conjunctival socket was 69.2%, and the predominant organism was S. epidermidis (38.5%). Potential pathogenic bacteria were found in 4 eyes with a 15% positive culture rate. The incidence of bacteria was significantly higher (85.4%) in patient samples with subjective symptoms compared to patients without symptoms (50%). The bacterial positive culture rate of the potential pathogen bacteria in the group with symptoms was higher at 21%, but was not statistically significant. CONCLUSIONS: Performing a pathogen culture test is necessary for prosthetic eye patients who complain of their symptoms. Additionally, the proper antibacterial treatment should be performed according to the antibiotics sensitivity of cultured bacteria.

A Case of Congenital Eyelid Retraction

PURPOSE: To report a case of congenital eyelid retraction with eyelid asymmetry. CASE SUMMARY: 12-year-old male patient visited our clinic with eyelid asymmetry, which had found 6 months after birth. On examination, his marginal reflex distance (MRD1) was 4.0 mm for right eye, and 7.5 mm for left eye. There was no significant notice from orbital computed tomography or laboratory findings and other factors that might have caused eyelid retraction were not found. As treatment, Botulinum toxin type A was injected under the upper tarsal conjunctiva. The upper eyelid retraction was relieved to MRD1 = 4.0 mm after 1 week and MRD1 = 5.5 mm after 1 month. This case was diagnosed as congenital eyelid retraction of upper eyelid. CONCLUSIONS: Diagnosis of congenital eyelid retraction should be considered to patients with eyelid asymmetry, and the symptom can be relieved with Botulinum toxin type A injection.

Development of a Conditional Replication Competent Adenovirus, Controlled by the Human Telomerase Promoter (hTERT) / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study has been planned to generate a replication-competent adenovirus which replicates in a cancer cell-specific manner, thus minimizing the side effects and toxicity of cancer gene therapy. MATERIALS AND METHODS: we have generated an E1B 19 kD attenuated recombinant adenoviruses, Ad-TERT-delta19 and Ad-mTERT-delta19, which encode E1A gene driven by the wild type hTERT and modified m-hTERT promoter containing additional c-myc and Sp1 binding sites in the backbone of Ad-deltaE1B19. The in vitro efficacy and specificity of the hTERT and m-hTERT promoter have been evaluated by the comparison of viral replication and cytopathic effect in cancer cells and normal cell lines. To assess anti-tumor effect and safety of hTERT or m-hTERT promoter driven replication competent adenoviruses, tumor regression after subcutaneous injection in subcutaneous C33A xenografts and lacZ expression after systemic injection in organs were examined. RESULTS: The activation of hTERT or m-hTERT promoter was significantly up-regulated only in hTERT-positive cells, but not in hTERT-negative cells. Moreover, the activity of m-hTERT promoter was substantially increased in hTERT-positive cancer cells, but not in hTERT-negative cells. While Ad-TERT-delta19 replicated in and induced cytopathic effect in cancer and in some normal cell lines, Ad-mTERT-delta19 enhanced viral replication and cytopathic effect in cancer cells only. Furthermore, the growth of established human cervical carcinoma in nude mice was significantly suppressed by intratumoral injection of Ad-mTERT-delta19. CONCLUSIONS: The use of m-hTERT promoter is not only useful in the regulation of therapeutic gene expression but also that replication-competent oncolytic adenovirus under the control of m-hTERT promoter may be a new promising tool for the treatment of human malignancies.

A Case of Extrapontine Myelinolysis with both Frontal Lobe Dysfunction and Decreased Perfusion in SPECT

A thirty-nine year old woman was consulted because of personality change, agitation and memory disturbance. She received chemotherapy and oral steroids because of carcinoma within the bronchus. She had a high serum osmolarity caused by hyperglycemia and hypernatremia, and it was corrected rapidly. Her brain MRI showed EPM (extrapontine myelinolysis). Brain SPECT showed hypoperfusion in the bilateral orbitofrontal regions. We report a patient with EPM with typical frontal lobe dysfunction as an initial manifestation and bilateral orbitofrontal hypoperfusion.

A Case of Secondary Erythromelalgia with Regional Arterial Blood Pressure Change between Symptomatic and Asymptomatic Period

No abstract available.

Analysis of Role of Peripheral Vestibular Receptors on Orthostatic Tolerance using Heart Rate Variability in Rats

BACKGROUND: There is substantial evidence that the vestibular system is involved in the regulation of blood pressure. Heart rate variability (HRV) is useful to investigate the role of the peripheral vestibular receptors and the baroreceptors in the orthostatic tolerance. METHODS: EKG was recorded during postural changes with the head up either after sinoaortic denervation or after bilateral labyrinthectomies in Sprague-Dawley rats. HRV, including mean, standard deviation, coefficient of variation (CV), and power spectrum, were analyzed from R-R intervals of EKG. RESULTS: Phenylephrine increased low frequency region and sodium nitroprusside increased high frequency region in the power spectral analysis of HRV in anesthetized rats. Postural changes decreased blood pressure transiently and then increased blood pressure gradually in control rats, but the depression of blood pressure induced by postural change was greater in rats with both sinoaortic denervation and bilateral labyrinthectomies. The increase of CV of HRV just after sinoaortic denervation or bilateral labyrinthectomies represents an unstable heart rate in resting position, however, CV of HRV was increased markedly by postural change 7 days after bilateral labyrinthectomies. Postural change with sinoaortic denervation increased low-frequency region representing sympathetic activity, whereas bilateral labyrinthectomies increased highfrequency region representing parasympathetic activity in power spectral analysis. CONCLUSIONS: These results suggest that both the peripheral vestibular receptors and the baroreceptors have subsidiary action in orthostatic tolerance and the peripheral vestibular receptors regulate blood pressure during postural change through the sympathetic nervous system.