Clinical Treatment Efficacy Using One-snip Punctoplasty and Irrigation Technique in Primary Canaliculitis Patients

Purpose@#This study aims to report the efficacy and safety of one-snip punctoplasty and 18-gauge irrigation technique in patients with primary canaliculitis. @*Methods@#All patients diagnosed with primary canaliculitis between January 2020 and August 2021 at Inje University Busan Paik Hospital are included. All patients underwent one-snip punctoplasty and 18-gauge irrigation technique. After the procedure, patients had topical antibiotics. The resolution of symptoms and inflammatory signs and complications were evaluated 3 weeks after the procedure. @*Results@#A total of 11 patients (eight female patients and three male patients, 14 canaliculi) aged 34 to 82 years with a mean age of 63.8 ± 15.7 years were participated. Common symptoms were epiphora, mucopurulent discharge, and injection, and common signs were discharge from punctum, pouting punctum, punctal erythema, and swellling. Among 14 canaliculi, 12 (85.7%) had complete resolution and two underwent second treatment which showed completed resolution after the treatment. @*Conclusions@#One-snip punctoplasty and 18-gauge irrigation technique are minimally invasive to punctum and canaliculi and are a highly effective surgical procedure for patients with primary canaliculitis.

Septic Cavernous Sinus Thrombosis Caused by Dental Infection

Purpose@#We report a case of bilateral septic cavernous thrombosis caused by a dental infection.Case summary: A 58-year-old male was transferred to our hospital because of left-sided proptosis and eyelid swelling. The patient had fever and left temporal headache, which did not respond to oral and intravenous antibiotics. After experiencing a tooth injury while chewing hard food 3 months ago, the patient developed toothache and swelling around the tooth for which he did not take any treatment. The patient had left eyelid edema, ptosis, chemosis, and conjunctival congestion. The left eye movements were limited in all directions. Brain magnetic resonance imaging showed dilatation and thrombosis of the left superior ophthalmic vein and thrombosis of bilateral cavernous sinuses. The patient was treated with systemic antibiotics and anticoagulants. The blood culture showed growth of Parvimonas micra and Dialister Pneumosintes, which are common causes of dental infection. @*Conclusions@#Septic thrombosis of the cavernous sinus and superior ophthalmic vein thrombophlebitis can occur due to the spread of dental infection. Prompt diagnosis and treatment are important for rapid resolution of symptoms and good prognosis.

Central Retinal Artery Occlusion after Filler Injection for Upper Lid Retraction

Purpose@#We report a case of central retinal artery occlusion after filler injection for upper lid retraction. Diagnosis and treatment were performed to recover visual acuity and good results.Case summary: A 40-year-old woman presented to our clinic with upper lid retraction. She was diagnosed with hyperthyroidism and thyroid orbitopathy. She had been examined regularly at a local clinic since 2016. At the first visit, her visual acuity was 1.0/1.0 and the intraocular pressure was 19 mmHg, with no unusual findings in the anterior segment. Hyaluronic acid filler was injected into the medial part of the left upper lid. As soon as the needle was removed, she complained of blurry vision and visual impairment. This was followed by the development of a relative afferent pupillary defect; her visual acuity was hand motion at 30 cm. After 5 minutes, we performed wide fundus imaging and optical coherence tomography, which revealed retinal artery occlusion and a cherry-red spot, along with inner retina hyperreflectivity. Under a diagnosis of central retinal artery occlusion, we performed anterior chamber paracentesis, intravenous mannitol and acetazole injection, and an ocular massage. Approximately 1.5 hours after filler injection, retinal artery reperfusion and loss of the cherry red spot were observed and, after about 3 hours, her vision had recovered to 1.0 from hand motion at 30 cm. @*Conclusions@#Central retinal artery occlusion after filler injection, when diagnosed promptly, can be treated by anterior chamber paracentesis, intravenous mannitol and acetazole injection, and ocular massage.

Silicone Tube Intubation with Lacrimal Endoscopy and Endonasal Dacryocystorhinostomy in Adult Nasolacrimal Duct Obstruction

Purpose@#To compare the success rate of silicone tube intubation using a lacrimal endoscope with that of endonasal dacryocystorhinostomy in adult acquired nasolacrimal duct obstruction with no canalicular obstruction. @*Methods@#Retrospective cross-sectional study including 21 patients (31 eyes) treated with silicone tube intubation using lacrimal micro-endoscope and 29 patients (37 eyes) who underwent endonasal dacryocystorhinostomy. We examined lacrimal irrigation, probing, and fluorescein dye disappearance before surgery. A total of 3 months after surgery, the silicone tube was removed. The success rates were determined based on symptoms and the results of lacrimal irrigation. @*Results@#For silicone tube intubation in the lacrimal endoscopy group, success rates 3 and 6 months after surgery were 87.1% and 71.0%, respectively. In the endonasal dacryocystorhinostomy group, they were 91.9% and 81.1%, respectively. There was no significant difference in success rates 3 and 6 months after surgery (p = 0.517 and p = 0.327, respectively). However, a significantly higher success rate (81.8%) was observed in the endonasal dacryocystorhinostomy group compared with the silicone tube intubation using lacrimal micro-endoscope group (66.7%) at 6 months after surgery if the patient had total regurgitation upon preoperative examination of lacrimal irrigation (p = 0.028). @*Conclusions@#There was no significant difference in success rates between silicone tube intubation using lacrimal endoscope and endonasal dacryocystorhinostomy in adult acquired nasolacrimal duct obstruction with no canalicular obstruction, although there was a lower success rate in patients with total nasolacrimal duct obstruction. Silicone tube intubation using lacrimal endoscope may reduce the frequencies and complications of unnecessary invasive operations and general anesthesia.

Efficacy and Safety of Letibotulinum Toxin A for the Treatment of Essential Blepharospasm

PURPOSE: To evaluate the efficacy and safety of BOTULAX® in subjects with essential blepharospasm.METHODS: In this study, a total of 250 subjects with essential blepharospasm were enrolled at 15 investigational sites and a total of 220 subjects completed the study. The efficacy and safety were evaluated at weeks 4 and 16 after treatment compared with baseline. In total, 240 subjects were enrolled, treated with the investigational product, and evaluable for the primary efficacy assessment at week 4 after treatment; these subjects were included in the intention-to-treat (ITT) population. With the ITT set as the main efficacy set, efficacy assessment included Jankovic rating scale (JRS), functional disability score, investigator evaluation of global response and quality of life. Safety assessment including the incidence of adverse events was also performed.RESULTS: In terms of the primary efficacy endpoint (i.e., change in JRS total score at week 4 after treatment from baseline [ITT set]), mean change indicated a statistically significant reduction (p < 0.0001) and demonstrated the non-inferiority of the test drug to similar drugs. In terms of the secondary efficacy endpoints, mean change in JRS total score at week 16 after treatment and mean change in functional disability score at weeks 4 and 16 after treatment both exhibited a statistically significant reduction compared with baseline (p < 0.0001 for all). Among the 249 subjects treated with the investigational product in this study, 44 (17.67%) experienced 76 treatment emergent adverse events but no serious adverse events were observed.CONCLUSIONS: Based on the study results, BOTULAX® is considered to be an effective and safe treatment for essential blepharospasm.

Silicone Tube Intubation with Lacrimal Endoscopy and Endonasal Dacryocystorhinostomy in Adult Nasolacrimal Duct Obstruction

Purpose@#To compare the success rate of silicone tube intubation using a lacrimal endoscope with that of endonasal dacryocystorhinostomy in adult acquired nasolacrimal duct obstruction with no canalicular obstruction. @*Methods@#Retrospective cross-sectional study including 21 patients (31 eyes) treated with silicone tube intubation using lacrimal micro-endoscope and 29 patients (37 eyes) who underwent endonasal dacryocystorhinostomy. We examined lacrimal irrigation, probing, and fluorescein dye disappearance before surgery. A total of 3 months after surgery, the silicone tube was removed. The success rates were determined based on symptoms and the results of lacrimal irrigation. @*Results@#For silicone tube intubation in the lacrimal endoscopy group, success rates 3 and 6 months after surgery were 87.1% and 71.0%, respectively. In the endonasal dacryocystorhinostomy group, they were 91.9% and 81.1%, respectively. There was no significant difference in success rates 3 and 6 months after surgery (p = 0.517 and p = 0.327, respectively). However, a significantly higher success rate (81.8%) was observed in the endonasal dacryocystorhinostomy group compared with the silicone tube intubation using lacrimal micro-endoscope group (66.7%) at 6 months after surgery if the patient had total regurgitation upon preoperative examination of lacrimal irrigation (p = 0.028). @*Conclusions@#There was no significant difference in success rates between silicone tube intubation using lacrimal endoscope and endonasal dacryocystorhinostomy in adult acquired nasolacrimal duct obstruction with no canalicular obstruction, although there was a lower success rate in patients with total nasolacrimal duct obstruction. Silicone tube intubation using lacrimal endoscope may reduce the frequencies and complications of unnecessary invasive operations and general anesthesia.

Updates to Clinical Information on Anticancer Immunotherapy

OBJECTIVE: Over the last several years, immunotherapy has become one of the most promising therapeutic options for cancer. This study aims to summarize the updates on cancer immunotherapy focusing on immune checkpoint inhibitors, such as programmed cell death-1 (PD-1), programmed death-ligand 1 (PD-L1), and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitors, which have received attention as new anticancer therapeutic agents. METHODS: A literature survey was carried out on PubMed to identify high-impact papers on cancer immunotherapy from 2010. The most recent data on clinical efficacy and safety have been included highlighting the response characteristics to recently approved immunotherapeutic agents. RESULTS: In various cancers, immune checkpoints are a means for cancer cells to evade the immune system. Furthermore, CTLA-4 and PD-L1 can be overexpressed, allowing malignant cells to evade T-cells. Numerous clinical trials have been performed to seek appropriate indication of these products in various cancer types. Among them, the most conspicuous types are melanoma, non-small-cell lung cancer, and head and neck cancer. The approval of ipilimumab by Food and Drug Administration (FDA) commenced a new era of cancer immunotherapy. This was followed by the approval of nivolumab and pembrolizumab. Currently, combination therapies are being investigated for various cancer types. CONCLUSION: In this study, we reviewed recently reported scientific and clinical evidence for currently approved immune checkpoint inhibitors. Although these novel checkpoint inhibitors are ever evolving for cancer therapies, there exist limitations that need to be overcome, indicating the necessity for further studies aiming to improve their efficacy, toxicity, and cost.

A Case of Surgical Diagnosis and Treatment of Idiopathic Orbital Myositis with Sudden Vision Loss

PURPOSE: We report a case of idiopathic orbital myositis with sudden onset of unilateral visual loss and hypertrophy of the lateral rectus muscle at the apex of the orbit that was diagnosed using orbital biopsy and treated with intravenous corticosteroids. CASE SUMMARY: We examined a 20-year-old woman who complained of decreased visual acuity and binocular diplopia for 2 weeks. She showed 40-prism diopter left esotropia at the primary position. Her visual acuity with eyeglasses was 0.7 and 0.2 in the right and left eyes, respectively. Brain magnetic resonance imaging (MRI) revealed a round mass on the left lateral rectus muscle at the apex of the orbit with optic nerve compression. We planned orbital biopsy to exclude orbital lymphoma and other biopsy-requiring diseases. After 3 weeks, the visual acuity of her left eye decreased to 0.02. Repeated MRI revealed enlargement of all extraocular muscles on the left orbit. With biopsy showing several lymphocytes infiltrating muscle fibers, we made a diagnosis of idiopathic orbital myositis. Intravenous injection of corticosteroids was administered during hospitalization. After 2 weeks of corticosteroid therapy, the visual acuity of her left eye was improved to 0.63, the esotropia disappeared, and the enlargement of the left lateral rectus muscle was improved on orbital MRI. CONCLUSIONS: For non-specific idiopathic orbital myositis located at the apex of the orbit and enlargement of the extraocular muscle in a short period with decreased visual acuity, administration of intravenous injection of corticosteroids before orbital biopsy could help restore vision.

The Change of Severity of Epiblepharon after Induction of Total Intravenous Anesthesia without Muscle Relaxant

PURPOSE: To investigate the changes of epiblepharon by evaluating the severity of epiblepharon before and after induction of general anesthesia (GA) with a muscle relaxant and total intravenous anesthesia (TIVA) without a muscle relaxant. METHODS: Thirteen pediatric patients (26 eyes) underwent surgery for epiblepharon under GA using a muscle relaxant and 19 pediatric patients (38 eyes) underwent surgery for epiblepharon under TIVA without a muscle relaxant. The severity of epiblepharon in each eye was scored according to skin-fold height (scored 1-4) and area of ciliocorneal touch (scored 1-3) while the patient was in the supine position before induction and after induction of GA. RESULTS: Skin-fold height scores and ciliocorneal touch area scores decreased after induction of GA with a muscle relaxant (skin-fold height score before GA: 2.42 ± 0.86, after GA: 1.87 ± 0.88 p-value < 0.001; ciliocorneal touch area score before GA: 2.05 ± 0.70, after GA: 1.61 ± 0.68, p-value < 0.001). In the TIVA group, skin-fold height scores and ciliocorenal touch area scores were not statistically different before and after GA (skin-fold height score before GA: 2.23 ± 1.18, after GA: 2.38 ± 1.10, p-value = 0.212; ciliocorneal touch area score before GA: 2.06 ± 0.74, after GA: 1.94 ± 0.80, p-value = 0.161). CONCLUSIONS: The change of epiblepharon severity was significantly reduced by induction of TIVA without a muscle relaxant and there was no recurrence of epiblepharon 3 months after surgery. When using TIVA without a muscle relaxant, the change of epiblepharon severity was reduced and thus, this method can help prevent its undercorrection.

The Change of Severity of Epiblepharon after Induction of Total Intravenous Anesthesia without Muscle Relaxant

PURPOSE: To investigate the changes of epiblepharon by evaluating the severity of epiblepharon before and after induction of general anesthesia (GA) with a muscle relaxant and total intravenous anesthesia (TIVA) without a muscle relaxant. METHODS: Thirteen pediatric patients (26 eyes) underwent surgery for epiblepharon under GA using a muscle relaxant and 19 pediatric patients (38 eyes) underwent surgery for epiblepharon under TIVA without a muscle relaxant. The severity of epiblepharon in each eye was scored according to skin-fold height (scored 1-4) and area of ciliocorneal touch (scored 1-3) while the patient was in the supine position before induction and after induction of GA. RESULTS: Skin-fold height scores and ciliocorneal touch area scores decreased after induction of GA with a muscle relaxant (skin-fold height score before GA: 2.42 ± 0.86, after GA: 1.87 ± 0.88 p-value < 0.001; ciliocorneal touch area score before GA: 2.05 ± 0.70, after GA: 1.61 ± 0.68, p-value < 0.001). In the TIVA group, skin-fold height scores and ciliocorenal touch area scores were not statistically different before and after GA (skin-fold height score before GA: 2.23 ± 1.18, after GA: 2.38 ± 1.10, p-value = 0.212; ciliocorneal touch area score before GA: 2.06 ± 0.74, after GA: 1.94 ± 0.80, p-value = 0.161). CONCLUSIONS: The change of epiblepharon severity was significantly reduced by induction of TIVA without a muscle relaxant and there was no recurrence of epiblepharon 3 months after surgery. When using TIVA without a muscle relaxant, the change of epiblepharon severity was reduced and thus, this method can help prevent its undercorrection.

Surgical Outcomes of Dacryocystorhinostomy in Lacrimal Drainage Obstruction after Systemic Chemotherapy or Radioactive Iodine Therapy

PURPOSE: To compare the outcomes of endonasal dacryocystorhinostomy in patients with secondary lacrimal drainage obstruction associated with systemic chemotherapy or radioactive iodine therapy. METHODS: We retrospectively reviewed the clinical records of patients diagnosed with secondary lacrimal drainage obstruction after systemic chemotherapy or radioactive iodine therapy for thyroid disease and surgical treatment by endonasal dacryocystorhinostomy between January 2009 and January 2015. The control group included randomly selected patients who underwent endonasal dacryocystorhinostomy after diagnosis of primary lacrimal drainage obstruction. RESULTS: Patients were separated into a chemotherapy group (13 eyes of 9 patients), a radioactive iodine therapy group (44 eyes of 32 patients), and a control group (50 eyes of 40 patients). Duration from the onset of systemic chemotherapy or radioactive iodine to the first epiphora symptom was shorter in the chemotherapy group than the radioactive iodine therapy group (p < 0.001). There was no significant difference between the three groups in success rate of endonasal dacryocystorhinostomy. CONCLUSIONS: Most patients with secondary lacrimal drainage obstruction associated with systemic chemotherapy or radioactive iodine therapy had successful outcome of endonasal dacryocystorhinostomy. The success rate of dacryocystorhinostomy was comparable to that in patients with primary lacrimal drainage obstruction.

The Clinical Efficacy of Cutanplast(R) Nasal Packing after Endonasal Dacryocystorhinostomy

PURPOSE: The purpose of this study was to investigate the clinical efficacy of Cutanplast(R) nasal packing after endonasal dacryocystorhinostomy. METHODS: The present study included a total of 76 adult patients (98 eyes) with primary acquired nasolacrimal duct obstruction who underwent endonasal dacryocystorhinostomy. Fifty-four eyes were packed with Cutanplast(R) and 44 eyes were packed with Merocel(R). Patient discomfort while the packing was in situ, degree of bleeding during the day after operation, functional and anatomical success rate, and postoperative complications such as synechiae, granulation, wound healing (osteal mucosal epithelium epithelization), and revision rate were compared between the packing materials. RESULTS: The Cutanplast(R) was significantly more comfortable and effective at preventing hemorrhage after endonasal dacryocystorhinostomy during the day following the operation. There was no significant difference between the two groups in postoperative anatomical and functional surgical success rate at 1 week, 1 month and 3 months. In comparison with postoperative complications, the Cutanplast(R) group showed a lower incidence of delayed wound healing (delayed epithelialization of the osteal mucosal epithelium) than the Merocel(R) group, whereas there was no difference in granulation, synechiae, or revision rate. CONCLUSIONS: The Cutanplast(R) nasal pack resulted in significantly less discomfort and less bleeding compared to the Merocel(R) nasal pack. Moreover, the Cutanplast(R) showed a lower proportion of delayed wound healing after endonasal dacryocystorhinostomy and had the advantage of low cost compared to other hemostatic nasal packing materials. Therefore, Cutanplast(R) nasal packing after endonasal dacryocystorhinostomy can be considered a comfortable, cost-effective and clinically-effective method.

Nasolacrimal Duct Obstruction after Radioactive Iodine Therapy for Thyroid Cancer

PURPOSE: To investigate the clinical manifestation of nasolacrimal duct obstruction after radioactive iodine therapy for thyroid cancer. METHODS: The authors examined 622 patients who were treated with radioactive iodine therapy after the operation for thyroid cancer from January 2009 to December 2011. Fourteen patients (18 eyes) were diagnosed nasolacrimal duct obstruction based on the lacrimal irrigation test, lacrimal probing test and dacryocystography in our oculoplastic clinic. We analyzed the dose of radioactive iodine therapy, number of treatments, clinical manifestation and treatment type by retrospectively reviewing the patients' medical records. RESULTS: The mean radioactive iodine dose (215.7 +/- 23.1 mCi, p = 0.01) and the mean number of treatments (1.36 +/- 0.50, p< 0.001) were significantly greater in 14 patients who had nasolacrimal duct obstruction than in patients who did not. The average onset of tearing symptoms occurred 10.2 months after radioactive iodine therapy. The mean time between correct diagnosis and therapy was 18.4 months. Three patients (3 eyes) had occlusion at the common cannaliculus and 11 patients (15 eyes) had occlusion at the nasolacrimal duct. Ten patients (13 eyes) underwent endonasal dacryocystorhinostomy for complete obstruction and 4 patients (5 eyes) underwent silicone tube intubation for partial obstruction. CONCLUSIONS: Nasolacrimal duct obstruction is a rare complication associated with radioactive iodine therapy for thyroid cancer, thus, clinicians should be aware of this complication and refer patients with symptoms of epiphora to the oculoplastic department for specialized evaluation and treatment.

The Effect of Rituximab, Cyclophosphamide, Vincristine, and Prednisolone (R-CVP) Chemotherapy in Patients with Ocular Adnexal Extranodal Marginal Zone B Cell Lymphoma of the Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma

PURPOSE: To report the effectiveness of rituximab, cyclophosphamide, vincristine, and prednisolone (R-CVP) combination chemotherapy in patients with ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma (OAML). METHODS: R-CVP chemotherapy was performed in 7 patients (8 eyes) with a confirmed histopathological diagnosis of OAML from January 2012 to December 2012. A total of 6 cycles were administered at a 3-4 week interval and 2 cycles of rituximab were added at the third week. Response evaluation was performed 3 times, with the first evaluation 3 weeks after the third cycle, the second 3 weeks after the sixth cycle, and the last after the second rituximab cycle. RESULTS: In all 7 patients (8 eyes) with R-CVP, symptoms were improved, and the mass was markedly resolved based on orbit CT and MRI scan at first response evaluation. Clinically complete remission (CR) was achieved in 6 patients and partial response (PR) in 1 patient. At final response assessment, there was no detectable mass on orbit CT or MRI. There were no severe infections or hematologic adverse effects including neutropenia or decreased immunoglobulin during the follow-up period. CONCLUSIONS: In OAML, R-CVP combination chemotherapy is considered an effective, safe and important therapeutic approach, reducing the limitations of classic localized radiotherapy and combination chemotherapy and improving the remission rate.

A Case of Bilateral Septic Cavernous Sinus Thrombosis after Facial Trauma

PURPOSE: We report a case of a patient with ptosis, lid swelling, limitation of ocular movement, and visual disturbance after a trauma. The patient was diagnosed with unilateral orbital cellulitis, ophthalmic vein thrombosis and bilateral septic cavernous thrombosis and treated. CASE SUMMARY: After head and facial area trauma that occurred 1 month earlier, a 56-year-old man suffered from ongoing visual loss, limitation of ocular movement in all directions, proptosis in the left eye and abduction limitation of the right eye. A week before admission, mild fever and chills were also present. At admission, visual acuity of the left eye was no light perception and pupil reflex was lost. Brain MRA and MRI indicated dilation and thrombosis of the left superior ophthalmic vein, left orbital cellulitis and inflammation in bilateral cavernous sinuses. The patient was immediately treated with systemic antibiotics and steroid injection. Coagulase negative staphylococci were detected in blood culture. CONCLUSIONS: Infection caused by facial trauma spread through the facial area's venous plexus and caused orbital cellulitis. As a result, septic cavernous sinus thrombosis and ophthalmic vein thrombophlebitis occurred. Serious complications can occur after facial trauma, thus rapid differential diagnosis and appropriate treatment are important in determining prognosis.

The Clinical Outcome of Endoscopic Silicone Tube Intubation for Congenital Nasolacrimal Duct Obstruction

PURPOSE: To evaluate the surgical results and clinical effectiveness of silicone tube intubation through Hasner's valve under intranasal endoscopic guidance in children with congenital nasolacrimal duct obstruction (CNDO). METHODS: The present study enrolled a total of 58 eyes of 46 children over 12 months of age diagnosed with CNDO in the Department of Ophthalmology, Inje University College of Medicine from 2003 to 2010. Patients who had previously undergone ineffective probing or had a combination of an anatomical abnormality such as secondary nasolacrimal duct obstruction were also included. The silicone tube was intubated through the Hasner's valve and observed with intranasal endoscopy; tube retention time was planned for at least 12 weeks. RESULTS: A total of 20 eyes were previously probed preoperatively (mean 1.7 times). After the average follow-up period of 13.5 months, the overall success of silicone intubation was 57 of 58 eyes (98%). In one failed eye, nasolacrimal obstruction was already combined preoperatively, and unintentional tube removal by the patient occurred within one week. Silicone tube reintubation was performed after four months, and CNDO symptoms improved. CONCLUSIONS: Intranasal endoscopic observation to ensure the passage of a silicone tube through Hasner's valve decreases anatomical injury. When considering patient age and former treatment, silicone tube intubation with intranasal endoscopic observation could produce desirable results with a higher success rate.

The Effect of Breath-Hold Diving on Intraocular Pressure, Optic Nerve, Visual Field in Korean Haenyeo (Female Divers)

PURPOSE: To examine how breath-hold diving activities of Korean haenyeo female divers affect intraocular pressure (IOP), optic nerve and visual field (VF). METHODS: Basic ophthalmologic tests were performed for a group of breath-hold female divers (26 eyes) and a control group of non-divers (26 eyes) and the results compared between the 2 groups. For the breath-hold female diver group, a questionnaire survey was conducted on the patterns of breath-hold diving and the correlation with abnormalities in IOP, optic nerve and VF analyzed. RESULTS: IOP was significantly higher in the diver group (diver group: 15.00 +/- 3.76 mm Hg, control group: 13.93 +/- 2.36 mm Hg, p < 0.05). Between the 2 groups, the cup area (diver group: 1.21 +/- 0.60 mm2, control group: 0.83 +/- 0.46 mm2, p < 0.05), the cup-to-disc (C/D) ratio (diver group: 0.44 +/- 0.21, control group: 0.31 +/- 0.14, p < 0.05), and the vertical C/D ratio (diver group: 0.70 +/- 0.17, control group: 0.51 +/- 0.12, p < 0.05) were also significantly different. A significant correlation between working hours per day and IOP (r = 0.44, p < 0.05), between diving depth and RNFL defect, and cup area, and vertical C/D ratio (r = 0.43, r = 0.41, r = 0.39, p < 0.05) was observed. CONCLUSIONS: Subjects who breath-hold dive for a long period, such as Korean Haenyeo, need to have a glaucoma test regularly.

A Case of Iatrogenic Horner's Syndrome after Video-Thoracoscopic Surgery for Primary Pneumothorax

PURPOSE: To report a case of iatrogenic Horner's syndrome after video-thoracoscopic surgery for primary pneumothorax. CASE SUMMARY: An 18-year-old man with ptosis in the right eye was referred to our clinic. The patient had undergone wedge resection via video-thoracoscopic surgery for primary pneumothorax three weeks previously. On ocular examination, the palpebral fissure width was 7 mm in the right lid and 8 mm in the left lid, the marginal reflex distance 1 (MRD 1) was 2 mm in the right lid and 3 mm in the left lid, and the bilateral levator muscle function was good. Anisocoria was present, and pupil size in a dark room was 2.5 mm in the right eye and 4 mm in the left eye. The patient complained of facial anhidrosis on the right side of the face. CONCLUSIONS: Although iatrogenic Horner's syndrome is rare complication of video-thoracoscopic surgery for primary pneumothorax, diagnosis after surgery of the thoracic cavity should be made carefully.

Comparison of Surgical Outcomes between Trabeculectomy and Aqueous Shunt Surgery in Patients with Iridocorneal Endothelial Syndrome

PURPOSE: To compare surgical outcomes and corneal endothelial cell densities in patients with glaucoma secondary to iridocorneal endothelial (ICE) syndrome who underwent trabeculectomy with mitomycin-C (MMC) versus those who underwent Ahmed Glaucoma Valve (AGV) implantation. METHODS: Twenty-one patients with ICE syndrome who underwent either trabeculectomy with MMC or AGV implantation were included in this study. All patients had more than 12 months of follow-up after glaucoma surgery. Intraocular pressure (IOP), visual acuity (VA) and corneal endothelial cell density were compared according to the method of surgery. RESULTS: Ten eyes had undergone a trabeculectomy with MMC, and 11 eyes had an AGV implantation. In eyes that underwent a trabeculectomy with a MMC, there were no statistically significant differences between preoperative and postoperative month 12 in IOP, VA or corneal endothelial cell density. In eyes that underwent AGV implantation, postoperative IOP, VA and corneal endothelial cell density were statistically significantly lower than the preoperative values. CONCLUSIONS: When determining the method of glaucoma surgery in patients with ICE syndrome, the additional procedures needed to maintain the surgical success of trabeculectomy with MMC and the corneal decompensation which is caused by a decrease in corneal endothelial cell density after AGV implantation should be considered.

A Case of Primary Orbital Synovial Sarcoma

PURPOSE: To report a rare case of primary orbital synovial sarcoma. CASE SUMMARY: A 55-year-old male visited our clinic with a 2-month history of decreased visual field in the left eye. The best corrected visual acuity of the left eye was 1.0, and 2.5 mm of proptosis was observed. There was slight limitations in motility and a mild visual field defect in the inferotemporal quadrant of the left eye. Funduscopic examination of the left eye revealed papilledema. Orbital magnetic resonance imaging (MRI) demonstrated the presence of an orbital mass that extended inferotemporally into the left orbit. On magnetic resonance imaging, a well-demarcated and 2.7 x 2.0 x 2.2 cm sized tumor was identified with intermediate signal intensities on T1/T2-weighted scans with slight homogenous enhancement. We approached the orbital mass using a lateral conjunctival incision with left canthotomy and cantholysis and performed partial surgical resection of the mass because the mass encircled the optic nerve. The mass was diagnosed as synovial sarcoma based on the findings of both histopathology and immunohistochemical staining. Postoperatively, the patient underwent radiation therapy to the rest of the tumor site. CONCLUSIONS: Synovial sarcoma should be considered in the differential diagnosis of an orbital mass lesion encircling the optic nerve. Radiation therapy is useful to treat completely unresectable primary synovial sarcoma.