Prevalence and Clinical Features of Sagging Eye Syndrome in Korean Patients

Purpose@#To retrospectively analyze the relative frequency and describe the clinical features of sagging eye syndrome in Korean patients from a single center. @*Methods@#We retrospectively analyzed the medical records of patients with diplopia, aged over 40 years, who visited Chosun University Hospital from January 2018 to December 2020. The relative frequency of sagging eye syndrome was examined by classifying the cause of diplopia. Clinical features, such as age, sex, strabismus type, angle of deviation, treatment method, and prognosis were evaluated. @*Results@#A total of 128 patients were identified, of which 23 (18%) were diagnosed with sagging eye syndrome, including 12 male patients (52.2%) and 11 female patients (47.9%). Their mean age was 74.6 ± 7.6 years (range, 61–89 years), and all patients were over 60 years. Among the 62 patients with diplopia and age over 60 years, the relative frequency of sagging eye syndrome was 23 (37.1%), the highest among all age groups. Among the 23 patients with sagging eye syndrome, nine patients (39.1%) had only distance esotropia, with a mean distance esotropia value of 10.1 ± 8.6 prism diopters (PD) (range, 4–25 PD) at the first visit; nine patients (39.1%) had a combination of esotropia and vertical strabismus, with a mean esotropia value of 6.2 ± 4.8 PD (range, 2–12 PD) and a vertical angle of 4.7± 3.2 PD (range, 2–10 PD); and five patients (21.7%) had only vertical strabismus, with an average vertical strabismus angle of 3.3 ± 1.6 PD (range, 4–8 PD). Furthermore, 17 out of 23 patients (73.9%) used prism glasses, in whom the symptoms of diplopia disappeared. Finally, only three patients (13.0%) underwent surgery. @*Conclusions@#Sagging eye syndrome in Korean patients was identified in those over 60 years with a similar male-to-female ratio. Moreover, nonsurgical treatments, such as prism glasses, largely helped relieve the symptoms of sagging eye syndrome.

New Biodegradable Drug Delivery System for Patients with Dry Eye

Purpose@#This study aimed to develop a new type of drug delivery system (DDS) for treatment of dry eye. @*Methods@#A new lens-type biodegradable DDS was manufactured using gelatin methacryloly, antibiotics, and conjunctival epithelial cells as bio-inks in a Bio X 3D Bioprinter. Gelatin methacryloly was used as a base, and the conditions were analyzed to maintain the overall shape by using a mixture of 0.1%, 0.15%, and 0.3% hyaluronic acid. In addition, an experiment was conducted to measure the appropriate concentration by evaluating its cytotoxicity according to the concentration of antibiotics mixed therein to prevent infection. The degree of degradation according to the storage temperature and post-processing of the new lens-type biodegradable DDS was measured. @*Results@#Optimal conditions were maintained when using a nozzle pressure of 80 kPa and speed of 4 mm/sec, nozzle pressure of 50 kPa and speed of 3 mm/sec, nozzle pressure of 60 kPa and speed of 8 mm/sec for 0.1%, 0.15%, and 0.3% hyaluronic acid concentrations, respectively. Degradation did not occur at 4°C and all the lenses were degraded at 37°C within 24 hours. In addition, the degradation rate was delayed according to the ultraviolet crosslink treatment time. Tobramycin 1% was used as an antibiotic during manufacture. @*Conclusions@#A new lens-type biodegradable DDS that can control the degree of degradation was designed using a 3-dimentional bioprinter. This DDS will contribute to ease of treatment, protection of the cornea, and regeneration of the epithelium in patients with dry eye.

Primary Amyloidosis Localized to the Conjunctiva

PURPOSE: To report a case of primary amyloidosis localized to the conjunctiva. CASE SUMMARY: A 19-year-old male with a conjunctival mass and foreign body sensations in the right eye transferred from another hospital. A 0.5 × 2.5 cm reddish mass was present in the medial canthus of the right conjunctiva with no other clinically specific signs. Surgical excisional biopsy was performed. Histological examination showed amyloid deposition. There was no other orbital involvement apart from the conjunctiva. Abnormalities were not found in the systemic examination. CONCLUSIONS: We report a case of primary amyloidosis localized to the conjunctiva.

Endogenous Endophthalmitis by Hypervirulent Klebsiella Pneumoniae Invasive Syndrome

PURPOSE@#To report a case of endogenous endophthalmitis with an elbow abscess spread from a liver abscess in a patient with hypervirulent Klebsiella pneumoniae (hvKP) invasive syndrome.CASE SUMMARY: A 33-year-old healthy male presented with painless visual loss in his right eye. He experienced pain, a febrile sensation, and swelling in his right elbow for 1 week prior. He had no trauma history. Many inflammatory cells, hypopyons, and cyclitic membranes were present in the anterior chamber of the eye but no ocular injection was performed. With a provisional diagnosis of panuveitis, topical antibiotics, steroid, and cycloplegics were administered and subtenon triamcinolone was injected. After orthopedic consultation, an elbow abscess was suspected and surgery was performed. Two days after the surgery, the patient experienced ocular pain and an injection was performed. Fever, chill, and acute deterioration of his general condition were noted which suggested infective endophthalmitis. Emergency vitrectomy was performed but because subretinal and choroidal abscesses were observed during surgery, the surgery was changed to enucleation. A liver abscess was observed using abdominal computed tomography after transfer to the infection medical department and hvKP was positive in the blood, liver, elbow, and eye cultures.@*CONCLUSIONS@#A primary liver abscess caused by hvKP occurred in a healthy young man and metastatic infection occurred with endogenous endophthalmitis and a rare elbow abscess. Because hvKP endogenous endophthalmitis has a poor prognosis, rapid diagnosis followed by appropriate treatment is required.