Retinal Toxicity Following the Injection Ganciclovir into Silicone Oil-filled Eye to Treat Acute Retinal Necrosis

PURPOSE: To report a case of retinal toxicity after an intravitreal ganciclovir injection to treat acute retinal necrosis in an eye filled with silicone oil.CASE SUMMARY: A 56-year-old male presented with ocular pain and visual loss in his right eye. His best-corrected visual acuity was 20/25, inflammatory cells in the anterior chamber, multiple retinitis lesions and retinal vessel occlusions in the peripheral retina and vitreous opacity were showed. Acute retinal necrosis was suspected, anterior chamber polymerase chain reaction (PCR) test was done. Aciclovir 2,400 mg/day intravenously and ganciclovir 2.0 mg were administered by intravitreal injection. After 4 days, retinitis was worsened and PCR test was positive for varicella zoster virus. Ganciclovir intravitreal injections were increased twice a week. After 16 days, retinal detachment occurred, so scleral encircling, vitrectomy, laser photocoagulation, and silicone oil tamponade were conducted. Ganciclovir 1.0 mg was injected at the end of surgery. The patient's visual acuity decreased to hand motion, and multiple crystal deposits with multiple retinal hemorrhages were observed in the right eye the next day. Visual acuity did not recover and optical coherent tomography showed that the macula was thinned.CONCLUSIONS: Visual loss seemed to be related with the retinal toxicity of ganciclovir. The increased local concentration due to the silicone oil tamponade is thought to have caused the toxicity.

Initial Clinical Manifestations of Ocular Ischemic Syndrome in Koreans

PURPOSE@#To evaluate the clinical features of ocular ischemic syndrome in Koreans.@*METHODS@#The medical records of patients who were presumed to have ocular ischemic syndrome by ophthalmic examination, and confirmed by carotid artery imaging, were retrospectively reviewed from 2010 to 2017.@*RESULTS@#A total of 22 patients and 27 eyes were included in the study. Twenty patients were male. The average age was 64.2 years. Fifteen patients had hypertension and fifteen patients had diabetes mellitus. Twenty-one patients presented with acute visual impairment at the initial visit. The average best-corrected visual acuity (BCVA) was a LogMAR of 0.89 ± 0.65, with an average IOP of 16.1 ± 6.9 mmHg. Elevated IOP > 21 mmHg was noted in five eyes (18.5%). Iris neovascularization was the most common (13 eyes, 48.1%) feature in the anterior segment. Retinal hemorrhage was the most common feature in the fundus examination (23 eyes, 85.2%). The average central submacular thickness was 255.0 µm, and there was no macular edema except for one case with vitreomacular traction syndrome on optical coherent tomography.@*CONCLUSIONS@#A total of 90.9% of patients with ocular ischemic syndrome were males > 50 years of age. Most patients presented with acute visual impairment. There was no macular edema on optical coherent tomography of all eyes.

Clinical Characteristics of Intraocular Foreign Bodies According to Entrance Location: Corneal vs. Non-Corneal

PURPOSE: To investigate differences in the clinical features of post-traumatic intraocular foreign bodies (IOFBs) according to their entrance locations, specifically, those penetrating the cornea and those not penetrating the cornea. METHODS: A retrospective chart review was performed of patients with an IOFB from January 2011 to July 2016. The patients were divided into two groups: those in whom the IOFB entered through the cornea (“corneal entrance” group) and those in whom the IOFB did not penetrate the cornea (“non-corneal entrance” group), and compared. Damage to the anterior and posterior capsule, retinal tear, and retinal detachment were analyzed, and differences in surgical techniques including the IOFB extraction route and intraocular lens implantation were recorded. RESULTS: A total of 43 eyes (43 patients) were included, with 33 (76.7%) in the corneal entrance group and 10 (23.3%) in the non-corneal group. The posterior capsule was preserved in 24.2% (eight) of eyes in the corneal group and 80% (eight) of eyes in the non-corneal group. The corneal group had significantly more posterior capsule ruptures but dramatically fewer retinal tears (39.4%) than the non-corneal group (80% retinal tears). CONCLUSIONS: The location of IOFB entrance is a predictable factor of lens capsule and retinal injuries.

The Shortest Radius of Curvature of Bruch's Membrane in Macular Optical Coherence Tomography

PURPOSE: To develop software to measure the shortest radius in curvature of Bruch's membrane from optical coherence tomography (OCT), and then to apply it to various types of eyes. METHODS: Macular OCT images consisting of 12 images of 9 mm radial scans were studied. The horizontal to vertical pixel ratios were changed to 1:1, and Bruch's membrane was marked automatically on each image. Software to measure the radius of Bruch's membrane curvature was developed. The shortest radius on each image was defined as r (mm) and the average r of 12 images was defined as R (mm). The reciprocal of R was multiplied by the constant, 337.5, which was defined as the posterior staphyloma (PS) index. RESULTS: The OCT images of five eyes were analyzed by the software, which could calculate the curvature of Bruch's membrane automatically. The PS indices were 12.7, 23.7, and 66.4 in eyes without refractive error (Case I), in the high myopic group without posterior staphyloma (Case II), and in the high myopic group with posterior staphyloma (Case V), respectively. The PS index gradually increased according to aging in a 37-year-old patient (Case IV) with mild staphyloma from 34.6 to 39.5 over 4 years. CONCLUSIONS: PS index is a novel parameter to reflect the level of posterior staphyloma, but further studies are needed to apply it to clinical patients.

Relationship among Dominant Eye & Hand and Deviated Eye under General Anesthesia

PURPOSE: To evaluate the association between ocular dominance, hand dominance and eye deviation in orthophoric and strabismus patients under general anesthesia during surgery. METHODS: The subjects were divided into 2 groups. Group 1 was composed of 38 patients who underwent strabismus surgery and group 2 was composed of 107 patients who underwent non-strabismus surgery under general anesthesia. Best corrected visual acuity (BCVA), dominant hand and fixating eye were obtained before surgery, and ocular dominance was assessed using the hole-in-the-card test. Under general anesthesia, we took a digital photo of both eyes, and the deviating eye was determined. RESULTS: Under general anesthesia, the deviated eye showed no statistically significant correlation to the dominant eye and dominant hand in group I, respectively (p = 0.61, 0.74, respectively). In group II, there was no correlation between the deviated eye and the dominant eye (p = 0.65). The deviated eye also showed no correlation to the dominant hand in group II (p = 0.61). CONCLUSIONS: There was no correlation between the dominant and deviated eye under general anesthesia in the strabismus surgery group and the non-strabismus surgery group. Also, there was no correlation between the dominant hand and the deviated eye in patients under general anesthesia in the 2 groups.

Pharmacologic Effects of Atropine Penalization in Amblyopic Eyes

PURPOSE: To analyze the pharmacologic effect of atropine penalization in amblyopic eyes. METHODS: Distant and near visual acuity, near point of accommodation (NPA), and pupil size were measured in the sound eye of 40 children with amblyopia before and after receiving atropine sulfate 1% solution. Amblyopic children were divided into 2 groups according to the time of follow-up visit: 4-days and 7-days after injection; the same tests were performed on all the scheduled follow-up visits. This study included a control group of 20 normal children who received the same test on the initial visit and the scheduled follow-up visits. RESULTS: Visual acuity of the sound eye at distance showed greater decreases in children with 4-day follow-up visits compared with 7-day visits in the amblyopic group (p = 0.24). There was no significant difference in near visual acuity between the amblyopic group and the normal control group by follow-up interval (p = 0.98, p = 0.75). Near point of accommodation significantly increased in the 4-day visit group in both the amblyopic and the normal control groups (p = 0.04 and p = 0.03, respectively), Pupil size was significantly maintained in the 4-day visit, amblyopic group (p = 0.01). CONCLUSIONS: Atropine effectively decreased the vision of the sound eye in amblyopic children. However, to maintain the pharmacologic effect, two separate atropine instillations per week (on a weekday and the weekend) should be considered as a treatment for amblyopia.

The Effect of Atropinization of Refractive Accommodative Esotropia Patients with Amblyopia

PURPOSE: The present study examined the effect of amblyopia treatment by applying atropine to patients with refractive accommodative esotropia and amblyopia. METHODS: The subjects were chosen from patients who visited the Wonju Christian Hospital for esotropia between July 2000 and July 2002. The subjects of this study included 15 patients who had refractive accommodative esotropia and amblyopia, 7 patients who could not receive visual acuity tests and showed monocular fixation. Atropine was applied to the 22 subjects, and its effect in treating amblyopia was examined. RESULTS: The fixation changed from monocular esotropia to alternating strabismus, or from healthy eye to amblyopia in 20 subjects (90.9%). Alternating strabismus continued since the dropping of atropine was stopped after the treatment of 17 subjects (77.3%), and fixating eyes changed to sound eyes in 5 subjects (22.7%). For patients who could receive visual acuity tests, 2 patients (13.4%) showed that those visual acuity did not improve by one line on the Snellen chart, and 13 patients (86.7%) showed improvement by two or more lines. CONCLUSIONS: In the present study, the effect of atropine applied to patients with refractive accommodative esotropia and amblyopia was not perfect in treating the amblyopia. However, 86.6% of them who could receive visual acuity tests showed improvement by two or more lines on the Snellen Chart, and 40.0% of them showed same visual acuity with sound eyes. In addition, in 77.3% of the subjects, the type of esotropia changed from monocular esotropia to alternating strabismus.

Juvenile Xanthogranuloma as an Isolated Corneoscleral Limbal Mass: a Case Report

A case of a juvenile xanthogranuloma of the corneoscleral limbus was encountered in a 5-year-old oriental boy, who presented with a 5-month history of a lump in the right eye. The lesion extended from the inferior limbus. This yellow-orange mass was vascular and firmly fixed to the underlying tissue. The lesion was diagnosed preoperatively as an atypical dermolipoma and an uneventful excisional biopsy was performed. The pathologic diagnosis showed the characteristic picture of a juvenile xanthogranuloma with numerous Touton giant cells. Dermoid and lipodermoid tumors, as a corneoscleral limbal mass, are the most frequently encountered in childhood. A juvenile xanthogranuloma is a rare and usually benign skin disease with an unknown cause, which occurs in infants and young children. However, it can occur also as a corneoscleral limbal mass in young children.

Effect of Melatonin on the Cisplatin Induced Ototoxicity in Rats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cisplatin (CP), an antitumor agent widely used in the treatment of head and neck cancers, has side effects such as ototoxicity and nephrotoxicity. These side effects are closely related to oxidative stress. In the present study, we attempted to suppress CP-induced ototoxicity in rats by administering melatonin, an antioxidant. MATERIALS AND METHOD: Male Sprague-Dawley rats were divided into different groups and were treated as follows: 1) saline control, 2) CP (16 mg/kg, i.p.), 3) CP plus melatonin (10 mg/kg, i.p.). The rats were sacrificed at the 6th day after CP treatment. RESULTS: CP-treated rats showed increase in cochlear malondialdehyde, hydrogen peroxide, glutathione peroxidase and glutathione reductase levels, and the decrease in cochlear superoxide dismutase (SOD) and catalase levels. CP-treated rats showed markedly decreased in the number of stereocilia on the inner hair cells and mildly decreased in the number of outer hair cells in organ of Corti under the light and scanning electron microscopic examination. Light and electron microscopic findings, and cochlear hydrogen peroxide, malondialdehyde, SOD, catalase, glutathione peroxidase and glutathione reductase levels were restored in the rats injected with CP plus melatonin than those with CP alone. CONCLUSION: These results suggest that melatonin suppresses CP-induced ototoxicity via the suppression of the increased production of reactive oxygen species.

Clinical Evaluation of the Associated Ocular Injuries of Orbital wall fracture Patients

PURPOSE: To describe the demographics, etiologic factors, clinical presentations, and associated ocular injuries in orbital wall fracture patients. MATERIALS AND METHODS: We retrospectively analysed 172 eyes of 144 patients with orbital wall fractures who visited emergency room & department of ophthalmology from 2000 to 2001. Clinical features such as age, sex, causes of injury, sites of orbital wall fractures, associated ocular injuries, number of associated injuries according to the site of orbital wall fractures, site of orbital wall fractures according to the associated injuries, associated injuries according to the number of orbital wall fractures. RESULTS:Total number of patients was 144 (172 eyes), 108 patients (75.0%) were men and 36 patients (25.0%) were women. Mostly, they were under 50 years of age. Traffic accidents (44.4%) was the most common cause of injury and medial wall (37.8%) was most common site of orbital wall fractures. Commotio retina (36.8%), Hyphema (8.8%), Eyelid laceration (19.3%), Traumatic optic neuropathy (5.7%) were most commonly associated injuries. The more number of wall fracture, the more occurred associated injuries. When more stronger force, such as lateral wall fracture, was accompanied, the associated injuries were more common. CONCLUSIONS: High prevalence of ocular and extraocular injury with orbital wall fractures emphasizes the need for a comprehensive ophthalmic evaluation and long-term follow-up.

Surgical Correction of Cilio-corneal Touch Combined with V-Y Advancement Flap

PURPOSE: The purpose of this study is to evaluate the functional and cosmetic results of V-Y advance-ment flap procedure to correct medial cilio-corneal touch. METHODS: The 8 patients with corneal erosion induced by medial cilio-corneal touch, whose post-operative follow up periods were longer than 3 months, were reviewed retrospectively. RESULTS: All patients underwent V-Y advancement flap procedure. Five patients (10 upper eyelids) under-went slinging procedures and 2 patients (3 lower eyelids) underwent epiblepharon repair simul-taneously. One patient (1 lower eyelid) showed recurrence of cilia touch but reoperation did not undertake. CONCLUSIONS: V-Y advancement flap procedure produced satisfied results functionally and cosmetically.

A Case of Fibrous Histiocytoma in Infratemporal Fossa and Parapharyngeal Space / 대한이비인후과학회지

Fibrous histiocytomas (FHs) are skin or deep tissue tumor that include a heterogenous group of tumors. The common origin of these tumors are a histiocyte and these tumors are composed of fibroblasts and histiocytes. FHs commonly occurs in the sun-exposed skin and subcutaneous tissue, but its incidence in the head and neck is rare. We experienced a case of FH in the infratemporal fossa and parapharyngeal space in a 29-year-old woman. The patient showed hyperesthesia in the right chin and some facial swelling. We could successfully remove the mass without sacrifice of important structures by infratemporal fossa approach with osteotomy of mandible.

Treatment Result in Laryngeal Cancer Patients Submitted to Surgical Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngeal cancer is the most common malignant tumor within head and neck and is known for having a good prognosis in comparison to the other malignancies. The surgery to the larynx and neck is one of the prime treatment modality for the laryngeal cancer. The purpose of this study is to review the surgical experience of our hospital and to focus on the results of the surgical treatment of the laryngeal cancer. MATERIALS AND METHODS: Analyzed 41 laryngeal cancer patients who underwent surgery during the period of 5 years from January 1989 to December 1993. TNM staging of the disease was done by the AJCC staging system issued in 1992. The 5-year survival rate was calculated by Kaplan-Meier method. RESULTS: 1) The overall 5-year survival rate was 65.8%. 2) The 5-year survival rate according to clinical stage showed 100%, 83.3%, 76.9%, and 50% in stage I, II, III, IV respectively. 3) The 5-year survival rate according to T stage showed 75%, 66.7%, 57.9%, 77.8%, in T1, T2, T3, T4 respectively. 4) The 5-year survival rate according to nodal status showed N(-) 78.9%, N(+) 56.2%. 5) The 5-year survival rate according to primary site showed supraglottis 60%, glottis 100%, transglottis 57.1%. 6) The 5-year survival rate according to treatment modalities showed surgery only patients 80%, postoperative radiation patients 60%, salvage operation patients 54.6%. CONCLUSION: Early stage, glottic cancer and the patients who only had operation showed good treatment result. Regional lymph node metastasis, at the time of diagnosis, was found to carry a worse prognosis. The main cause of treatment failure was distant metastasis.

Cavernous Sinus Lesions Treated in Otorhinolaryngology-Head and Neck Surgery Field / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cavernous sinus is a small venous space enclosed by leaves of dura and periosteum and located on either side of sella turcica. Approach and treatment of lesions of this sinus are very difficult and perilous because they contain critical neural and vascular structures. Surgery relating to cavernous sinus lesions are extremely rare in otorhinolaryngology and such surgeries are usually referred to the fields of neurology and neurosurgery. However, in the case of a lesion that extends from the nasal cavity and the paranasal sinuses, an intranasal approach is necessary and cooperation with head and neck surgeons are desirable to achieve a superior result. This study examines the nature of these rare cases of cavernous sinus lesions and assesses the results of cooperation with doctors of other specialties. MATERIALS AND METHODS: We summarize here three cases of cavernous sinus lesions (angiofibroma, tuberculosis, foreign body) extendeding from the nasal cavity and paranasal sinuses. These lesions were treated in cooperation with a reconstructive surgeon and a neurosurgeon. RESULT: All of these cases showed successful results. CONCLUSION: Close cooperation from each department is critical in order to achieve successful results.

Treatment of Posterior Epistaxis with Posterior Endoscopic Laser Photocoagulation / 대한이비인후과학회지

Epistaxis is a common otolaryngologic emergency. Posterior epitaxis is more frequent in the elderly and associates with hypertension and arteriosclerosis. This is apt to be more vigorous in volume, is more difficult to identify the active bleeding point, and is more troublesome to contol. A number of different treatments are used to control the posterior epistaxis. Some of these are deep anterior packing, posterior packing, nasal balloon tamponade, arterial ligation, arterial embolization and posterior endoscopic cautery. Recently we directly photocoagulated the bleeding points in 7 cases of posterior epistaxis using endoscope and KTP/532 laser. The epistaxis was controlled in all cases without any significant complication.